Manager, Provider Network - Medicare

Group 1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.

Why This Role Matters:

The Manager, Provider Network Management, is responsible for overseeing the contracting, provider relations,  and performance of the Medicare Advantage provider network. This role ensures that network adequacy, provider satisfaction, and operational integrity meet CMS requirements and organizational standards. The manager will lead a team focused on building strong provider relationships, monitoring performance metrics, and driving strategic initiatives to enhance member access, affordability, and quality of care.

We are primarily seeking candidates who reside in the state of Georgia or Colorado experienced in the Medicare provider network.

At Clear Spring Health, our mission is to simplify health to enrich lives. We believe in clarity, compassion, and connection — for our members, our providers, and our people. Our culture is built on five action-oriented pillars: Do What’s Right, Serve with Humility, Own It, Grow with Intention, and Innovate with Purpose.

How You'll Contribute:

Network Development & Contracting

• Oversee the recruitment, contracting, and onboarding of providers across all specialties to ensure network adequacy for Medicare Advantage markets.
• Negotiate provider agreements, fee schedules, and amendments in alignment with company policy and CMS regulations.
• Coordinate with the TPA to ensure accurate and up-to-date provider data in compliance with directory accuracy standards.

Provider Relationship Management

• Build and maintain strong, collaborative relationships with providers, health systems, and delegated entities.
• Oversee day-to-day provider relations functions including provider onboarding, engagement, and issue resolution
• Serve as an escalation point for complex provider issues, ensuring timely and satisfactory resolution.
• Monitor provider satisfaction and implement initiatives to improve the provider experience.

Regulatory & Compliance Oversight

• Ensure all contracting and credentialing activities adhere to CMS, state, and NCQA standards.
• Partner with Compliance and Credentialing teams to support pre-delegation audits, FDR attestations, and network adequacy submissions.
• Support CMS reporting and readiness activities, including provider directory validation and access-to-care analyses.

Performance & Operations

• Coordinate with the TPA to ensure proper and timely provider credentialing, and provider loading
• Lead a team responsible for provider issue resolution.
• Track and report key performance indicators (KPIs) such as network adequacy,  and provider satisfaction.
• Collaborate cross-functionally with TPA Claims, Configuration, and Credentialing, to ensure end-to-end network accuracy and performance.

Leadership & Collaboration

• Coach and develop staff, fostering a culture of accountability, collaboration, and continuous improvement.
• Contribute to annual strategic planning, budget development, and process-improvement initiatives.
• Represent Network Management in internal committees and external stakeholder meetings.

What We're Looking For:

Benefits Highlights:  

Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options.  Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability. All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required.  Employees may also participate in the Company’s 401K plan, with matching contributions by the Company.  

Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals.  All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.

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