Clinical QA Network Manager

Title : Network QA ManagerLocation : RemoteDuration : FTSummaryThe Network QA Manager is responsible for leading oversight operations, ensuring compliance with contractual, regulatory, clinical, and client requirements. This role manages end-to-end network oversight functions, client satisfaction monitoring, provider search tool performance, and provider panel card production to support organizational objectives and client commitments.Key Responsibilities1. Oversight Management · Lead all Network Oversight functions and team members. · Ensure compliance with Service Level Agreements (SLAs), regulatory requirements, and client contractual commitments. · Monitor performance metrics and implement corrective action plans as needed.2. Client Success Monitoring · Track, evaluate, and report client satisfaction and oversight outcomes. · Identify and resolve performance gaps through corrective action initiatives. · Develop reports and dashboards to present outcomes to leadership and clients.3. Provider Search Tool Oversight · Manage vendor partner relationships, including contracting and issue resolution. · Oversee provider search tool functionality, accuracy, and usability. · Ensure timely updates and enhancements to improve provider access for clients and members.4. Panel Cards Production · Manage production and distribution of provider panel cards in compliance with standards. · Oversee vendor performance, ensuring accuracy, and timely delivery. · Establish quality control measures for provider data integrity.5. Compliance and Oversight of Clinical Quality Measures · Coordinate with compliance and contracting departments limit exposure · Work with Medical Director to review and maintain effective clinical quality policies and procedures are in place.Qualifications· 7-10 years of experience in Network Management and or Group Health?· Experience working in or with Bill Review disciplines?· Strong written and verbal communications· Experience working in a matrixed organization and effective with multi-stakeholder management· Excellent relationship management and issue resolution skills· Enjoys managing talent at all levels; familiarity working with offshore teams a plus· Proven experience in vendor management· Excellent organizational, analytical, and communication skills