Job Summary

The Operations Project Manager is a key leader responsible for driving provider contracting and network development initiatives, with a primary focus on building and expanding preferred provider specialist networks across all markets. This role ensures the strategic growth of high-performing networks aligned with organizational goals and compliance with CMS regulations. A strong background in healthcare contracting, negotiation, and network strategy is essential, along with an understanding of Medicare Advantage, ACO models, and MSO workflows. The manager will lead contracting processes, support cross-functional teams, and serve as a subject matter expert on regulatory and operational priorities. This role requires excellent Excel skills, presentation development experience, and at least five years of healthcare operations experience.

Essential Duties And Responsibilities

• Lead the development and expansion of preferred provider specialist networks across all markets by identifying gaps and targeting high-performing providers.
• Oversee all provider contracting activities, including negotiation, execution, maintenance, and renewals of agreements, ensuring timely completion and regulatory compliance.
• Manage end-to-end onboarding processes for new providers, coordinating across credentialing, data entry, and operational teams.
• Collaborate with market leaders and internal stakeholders to develop market-specific network strategies based on performance data and adequacy needs.
• Maintain up-to-date knowledge of CMS guidelines, Medicare Advantage plans, ACO models (e.g., MSSP, ACO REACH), and MSO functions to guide contracting decisions.
• Represent the department in internal meetings, including compliance reviews, performance updates, and operational check-ins.
• Utilize Excel to perform data analysis and generate provider performance reports (e.g., VLOOKUP, pivot tables, IF statements).
• Develop and deliver clear, impactful presentations and slide decks for leadership and external partners.
• Monitor network compliance with regulatory timelines, quality standards, and audit requirements.
• Identify opportunities for operational improvements and recommend process enhancements to improve provider satisfaction and internal efficiency.
• Serve as a subject matter expert on provider network operations, advising leadership and cross-functional partners on best practices.
• Participate in ACO/CMS-related meetings and stay current on evolving program updates and compliance expectations.
• Perform other duties as assigned.
  
  

Knowledge, Skills And Abilities

• Strong expertise in provider contracting, network development, and healthcare negotiations.
• Deep understanding of Medicare Advantage, CMS regulations, ACO models, and MSO operations.
• Excellent communication and relationship-building skills with providers and internal stakeholders.
• Strong analytical skills; ability to interpret data and make strategic recommendations.
• Proficiency in Microsoft Excel, including advanced formulas and pivot tables.
• Skilled in creating professional, visually compelling PowerPoint presentations.
• Highly organized, adaptable, and capable of managing multiple priorities in a fast-paced environment.
• Collaborative team player with the ability to work independently and exercise sound judgment.
  
  

Minimum Education And Experience

• Bachelor’s degree in Healthcare Administration , Public Health, Business, Health Policy, or related field (or equivalent work experience).
• Minimum of 5 years of progressive experience in healthcare operations, with a strong focus on contracting, network management, or provider relations.
• Prior experience with CMS programs, Medicare Advantage, or ACO operations is highly preferred.
• Advanced proficiency in Excel and working knowledge of database or contract management tools.
  
  

About us: Genuine Health is building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through its Accountable Care Organizations (ACOs), the company aims to improve healthcare outcomes, achieve cost savings for the care of patients, and serve as a single point of contact to move doctors’ Medicare members into value-based care.

Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.