[Hiring] Manager - Network Quality and Management @MedRisk LLC

Role Description

The Manager of Network Quality & Management leads a dedicated team responsible for establishing and maintaining relationships with clinicians, hospitals, and healthcare providers while ensuring clinical quality standards, regulatory compliance, and continuous performance improvement across the provider network. This position leverages clinical expertise to oversee quality initiatives, establish clinical performance benchmarks, credential clinical providers, and guide both clinical and administrative staff to achieve high standards of clinical care and network performance.

• Develop and implement quality standards and network management strategies that drive clinician engagement, network growth, and retention across current and prospective service areas.
• Build and maintain trust-based relationships with clinicians, clinical leaders, and healthcare providers; serve as a liaison to understand practice patterns, clinical concerns, and needs.
• Partner with clinicians and clinical leaders to establish clinical quality improvement initiatives, benchmark clinical performance against best practices and standards, and identify gaps in clinical capabilities or service offerings.
• Conduct regular onsite clinical assessments with providers, utilizing clinical expertise and performance data to determine priority visits based on quality metrics, clinical outcomes, utilization patterns, member experience, and regulatory compliance indicators.
• Represent the organization as a clinical subject matter expert in provider meetings, regulatory forums, clinical conferences, and key healthcare events; position the organization for network expansion into new service areas and states (minimum 25% travel).
• Lead and facilitate clinical meetings with providers, medical groups, clinical advisory committees, and regulatory representatives using clinical knowledge to drive discussions.
• Attend key provider conferences and advisory committees to demonstrate leadership and subject matter expertise.
• Monitor and drive improvement in clinical quality metrics, clinical outcomes, and clinician satisfaction across the network; establish clinical performance dashboards and quality benchmarks aligned with industry standards and regulatory requirements.

Qualifications

• BA, BSN, or Current RN licensure in New Jersey, or Family Nurse Practitioner (FNP) / Acute Care Nurse Practitioner (ACNP) license/certification.
• 6+ years of provider relations or clinical nursing experience in direct patient care or clinical leadership roles.
• 3+ years of team leadership, clinical management, or quality improvement experience within a healthcare setting.
• Proven ability to establish and monitor key performance indicators.
• Proven ability to meet deadlines and manage competing priorities.
• Proven ability to influence course of action and build consensus across teams.
• Intermediate proficiency with Microsoft Word, Excel, and PowerPoint.
• Excellent organizational and project management skills.
• Strong verbal and written communication abilities.

Requirements

• Master of Science in Nursing (MSN), MBA, or Master of Health Administration (MHA) (preferred).
• Experience with compliance audits and regulatory oversight (preferred).
• Experience analyzing and interpreting complex healthcare data (preferred).
• Demonstrated experience managing staff in a healthcare setting (preferred).
• Experience with healthcare IT systems and tools (claims systems, provider portals, etc.) (preferred).
• Experience with program management within a health plan or provider organization (preferred).
• Knowledge of clinical credentialing, privileging, and peer review processes (preferred).
• Experience with multi-state network development, regulatory environments, or health plan expansion initiatives (preferred).

Benefits

• This position offers remote work flexibility while requiring travel within the service area as needed (minimum 25% travel expected for provider meetings and in-person visits).
• The role operates in a fast-paced, dynamic environment requiring strong attention to detail and excellent multitasking abilities.