Job Details

Provider Network Managers are the champions and advocates of our provider community. We don't just manage relationships-we build them, strengthen them, and elevate them through partnership, education, and trust.

We are seeking a Provider Network Manager II who is passionate about supporting providers and driving meaningful impact across our network. In this role, you'll collaborate directly with providers to solve complex operational and technical challenges, reduce risk, and promote compliant, high-quality practices that support both provider success and organizational excellence.

You will play a critical role in advancing provider programs and enterprise initiatives, managing escalated enrollment and complex issue resolution, and leading data-driven reporting and analysis to monitor performance and strengthen provider relationships. Through purposeful engagement-whether virtual or onsite-you'll deliver hands-on guidance, targeted education, and strategic solutions that improve quality, strengthen outcomes, and reinforce long-term provider partnerships.

This is a highly visible opportunity for a network leader who thrives on collaboration, accountability, and impact-and who believes that empowered providers are the foundation of strong healthcare systems.

Qualifications We're Seeking:

• Strong understanding of LTSS programs and EVV requirements
• Proven experience in network development and contract management

Candidates must live in Memphis TN or within 35 miles.

This job does require travel in the West TN Region.

Job Responsibilities

• Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
• Implementing, supporting, and monitoring provider programs and enterprise initiatives
• Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
• Handling escalated provider enrollment processing and problem resolution.
• Leading data reporting and analysis projects to monitor financial and service relations with providers.
• Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
• Able to travel to provider offices or conduct virtual meetings as required.

Job Qualifications

Education

• Bachelors degree in business or healthcare or relevant field or equivalent work experience required

Experience

• 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.

Skills/Certifications

• Ability to speak in public and conduct effective presentations.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Accuracy and attention to detail
• Effective time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• Ability to manage multiple projects and priorities
• Positive attitude, self-driven, engaging, proactive, results drive
• Knowledge in Medical terminology
• Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.

License

• Valid Driver's License

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the "Use of Non BCBST-Owned Vehicle" Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Number of Openings Available
1

Worker Type:
Employee

Company:
VSHP Volunteer State Health Plan, Inc

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.