Provider Network Lead, NY/NJ
Networks | Hybrid in New York, NY | Full Time | From $110,000 to $120,000 per year
Why CINQCARE is Different
CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to Black and Brown communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our Family Members’ race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.
About the Job
The Provider Network Lead, NY/NJ is responsible for the strategic growth, maintenance, and performance of a high-quality provider network within the designated geographic NY/NJ area. This role leads a team with a focus on day-to-day operations, across the geographically defined Markets with P&L accountability for value-based performance at the practice level. This position leads a team focused on both provider recruitment and ongoing provider account management, ensuring network adequacy, network composition to support the mission, cost-effectiveness, growth, attribution, top and bottom-line revenue, and quality of care for members. The NY/NJ Lead will develop and execute national recruitment strategies, build strong provider relationships, and drive network performance to meet organizational goals. The NY/NJ Network Lead will be responsible for managing the Network Account Manager role in collaboration with the Clinical Team. The Provider Network Lead will drive the Provider Experience and initiate process improvements to continually improve provider engagement.
This position reports to the Head of Network Development and Account Management. The Provider Network Lead, NY/NJ should embody CINQCARE's core values, including Trusted, Empathetic, Committed, Humble, Creative, and Community Minded.
Primary Responsibilities
The Provider Network Lead, NY/NJ will have the following responsibilities:
- Market based Network Strategy and Development:
- Develop and implement a Market based provider network expansion strategy aligned with overall business objectives and specific market needs.
- Conduct thorough market analyses within the region to identify target provider types, geographic areas for recruitment, and competitive landscape.
- Monitor network adequacy within the region, identifying and addressing gaps in coverage to ensure member access.
- Collaborate with internal stakeholders (e.g., contracting, finance, operations, local market leadership) to ensure seamless network integration and alignment with Market based priorities.
- Provider Recruitment:
- Lead and oversee the Market based provider recruitment team, setting performance goals, providing coaching and mentorship, and monitoring team performance.
- Develop and execute innovative and targeted recruitment strategies specific to the region, utilizing various channels (e.g., local medical society meetings, community events, online platforms, direct outreach).
- Negotiate contracts with providers, ensuring favorable terms, compliance with regulatory requirements, and alignment with Market based cost targets.
- Cultivate and maintain strong relationships with key provider stakeholders within the region, including physician groups, hospitals, ancillary providers, and community organizations.
- Account Management:
- Oversee the Market based provider account management team, ensuring ongoing provider satisfaction, engagement, and effective communication.
- Develop and implement Market based provider communication and engagement strategies, tailored to the specific needs of the region's provider community.
- Monitor provider performance against key metrics (e.g., quality, cost, utilization, member satisfaction) and implement strategies for improvement.
- Conduct regular provider meetings and site visits to address issues, provide updates, gather feedback, and strengthen relationships.
- Proactively address and resolve provider disputes and escalate complex issues as needed.
- Data Analysis and Reporting:
- Track and analyze key Market based network metrics, including provider recruitment, network adequacy, provider performance, and cost trends.
- Prepare regular reports for Market based and national leadership on network performance, strategic initiatives, and market dynamics.
- Utilize data to identify trends, opportunities for network improvement, and areas for cost containment within the region.
- Compliance and Quality Assurance:
- Ensure compliance with all relevant federal and state regulations and accreditation standards related to provider network management within the region.
- Implement quality assurance processes to monitor provider performance and ensure quality of care for members within the region.
- Budget Management:
- Manage the budget for provider recruitment and account management activities within the assigned region.
General Duties
The Provider Network Lead, NY/NJ should have the following duties:
- Leadership: The Provider Network Lead, NY/NJ will lead in defining and executing strategies and solutions to create business value in Networks, including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.
- Strategy: The Provider Network Lead, NY/NJ will suggest new programs, procedures and policies to continually improve efficiency and morale and to improve the employee experience.
- Collaboration: The Provider Network Lead, NY/NJ will participate in development of people objectives and systems, including metrics, queries, and standard reports for ongoing company requirements
- Knowledge: The Provider Network Lead, NY/NJ will provide subject matter expertise in the Network solutions, including determining and recommended approaches for Networks, solution deployment and performance evaluation.
- Culture: The Provider Network Lead, NY/NJ is accountable for creating a productive, collaborative, safe and inclusive work environment for the Network team and as part of the larger Company.
Qualifications
The Provider Network Lead, NY/NJ should have the following qualifications:
- Education: Bachelor's degree in healthcare administration, business administration, or a related field required; master’s degree preferred.
- Experience:
- Minimum of 5-7 years of experience in provider network management, with a focus on recruitment and account management, preferably within the assigned region.
- Demonstrated experience leading and managing teams.
- Strong understanding of healthcare reimbursement methodologies (e.g., fee-for-service, value-based care).
- Knowledge of healthcare regulations and compliance requirements specific to the region.
- Excellent negotiation, communication, and interpersonal skills, with the ability to build rapport with diverse provider groups.
- Strong analytical and problem-solving skills, with the ability to interpret data and identify trends.
- Proficiency in Microsoft Office Suite and network management software.
- Deep understanding of the specific healthcare market dynamics within the assigned region is essential.
- Entrepreneurial:
- CINQCARE seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. Aligning with CINQCARE clients, this position is accountable for ensuring CINQCARE is positioned to innovatively deliver on its promise.
- Communication:
- Excellent verbal, written communication, and presentation skills; Exceptional interpersonal and communication skills Proficiency in all Microsoft Office applications
- Relationships:
- Ability to build and effectively manage relationships with business leaders, coworkers, and clients.
- Maintain a high degree of confidentiality and discretion
- Culture:
- Good judgment, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding and entrepreneurial company.
CINQCARE provides all employees working an average of 30+ hours/week with the option to enroll in healthcare benefits. The cost of healthcare is shared between the company and the employee.
The working environment and physical requirements of the job include:
This position requires both in-home and office-based work. The job requires frequent travel for home visits and travel to physician offices, hospitals, sub-acute facilities, community partners and non-home-based market offices in all types of weather conditions. In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace.
In this position you will need an ability to travel frequently by car and/or public transportation, the ability to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 30 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.
