at Blue Cross Blue Shield of Kansas in Topeka, Kansas, United States
Job Description
At the direction of the Director of Operations, the Provider Network Data Program Manager is responsible for overseeing the strategic management and optimization of provider network data within Provider Network Solutions. This role involves ensuring the accurate collection, integration, and analysis of provider data to support network development, provider relations, and performance management. The Program Manager will collaborate with internal teams and stakeholders to enhance data-driven decision-making and improve network quality and efficiency.
What you’ll do
- Coordinate data updates, ensuring the provider network data reflects current contract statuses, specialties, locations, and credentialing information.
- Manage data-driven initiatives to optimize the provider network, including network adequacy requirements, performance, and capacity.
- In collaboration with and at the direction of the Director of Operations; design and implement programs to improve provider data quality, such as standardization initiatives, validation processes, and data cleansing projects.
- At the direction of the Director of Operations; liaise with corporate compliance related to individual provider data, credentialing audits.
- Identify needs requiring analysis to trends, gaps, and opportunities for improvement in the provider network structure and performance.
- Generate comprehensive reports for senior leadership, highlighting key performance indicators (KPIs) related to provider data, and network capacity.
- Develop tools and dashboards for tracking and visualizing provider network data.
- Collaborate with all business teams within Provider Network Solutions, divisional partners including IT and provider data analytics resources to ensure successful, integrated, and cohesive management of provider data.
- In collaboration with the Director of Operations, identify and collaborate with IT to implement process improvements for provider data management, including automation of data collection, validation, and reporting workflows.
- Support the development of new processes and tools to streamline provider data management and improve program outcomes.
- At the direction of the Operations Director, ensure that all provider data programs are in compliance with applicable healthcare regulations, including credentialing, accreditation, and regulatory standards (e.g., NCQA, URAC).
- Manage cross-functional projects related to provider network data, ensuring that project goals, timelines, and budgets are met.
- Monitor project progress, resolve any issues that arise, and provide regular updates to senior leadership.
- Apply project management methodologies to ensure the effective delivery of data-driven initiatives.
Knowledge/Skills/Abilities
- Strong expertise in provider network data management and healthcare data systems.
- Knowledge of healthcare accreditation standards (e.g. NCQA, URAC, CMS) and application of standards relative to documentation, procedure and policy requirements.
- Ability to direct the development of programs/processes related to compliance with external and accreditation standards and requirements.
- Experience with data integration, cleansing, and validation processes.
- Excellent project management skills, with experience managing cross-functional teams and complex projects
- Ability to apply and perform project initiatives relative to Agile / Scrum / Kanban / Sprint processes.
- Demonstrated strengths supporting collaboration and fostering effective working relationships to build project and strategy consensus through applying solutions.
- Communicate effectively, both orally and in writing with diverse
- Ability to develop and execute data-driven programs and initiatives.
- Familiarity with healthcare payer systems and healthcare policy.
- Must embrace and demonstrate the company’s core competencies and values of integrity, dependability, service, growth and progress, and courage.
What you need
- Bachelor's degree in healthcare administration, business, information technology, data science, or a related field preferred.
- 3+ years of experience in provider network management, data management, or a similar program management role in the healthcare industry.
- Certification in project management (e.g., PMP) or data analysis (e.g. Six Simga, Lean) preferred.
