Program Manager, Preferred Networks

📋 Description

• • As the Program Manager for Preferred Networks at Pearl Health, you will be instrumental in scaling the critical infrastructure that underpins our national, high-quality Preferred Provider Network (PPN). This role is central to enabling our preferred partners – encompassing non-primary care providers such as post-acute care facilities, specialists, and laboratories – to significantly reduce unnecessary healthcare costs and elevate the quality of care delivered to our Medicare Accountable Care Organization (ACO) populations.
• • You will be responsible for the day-to-day operational management and in-depth analytics of our PPN. This involves transforming complex claims data into actionable insights that drive strategic growth opportunities and enhance network performance. This is a unique opportunity to join a high-growth, high-performance business unit where your expertise in project management, analytical rigor, and operational ownership will have a direct and tangible impact on improving patient outcomes and fostering a more sustainable healthcare system.
• • Pearl Health is dedicated to empowering primary care providers, health systems, and physician-led networks to thrive in the evolving landscape of value-based care. Our comprehensive platform provides the essential technology, financial tools, and expert services that enable practices to deliver more proactive and effective care to their Medicare patients, ultimately leading to reduced costs and better health outcomes.
• • Founded in 2020, Pearl Health is driven by a team of healthcare and technology innovators, supported by leading investors including Andreessen Horowitz, Viking Global Investors, and AlleyCorp. We proudly partner with thousands of providers across 44 states, collectively working towards a more sustainable future for American healthcare.
• • In this role, you will serve as the strategic operational and analytical engine for our Preferred Provider Network. Your primary focus will be on managing network performance and developing the scalable systems and tactical approaches necessary to support our ongoing expansion and growth.
• • Key responsibilities include: Analyzing complex claims data to pinpoint high-impact PPN targets and formulating data-driven recommendations for network optimization. This involves a deep dive into healthcare utilization patterns and cost drivers to identify areas for improvement.
• • You will assist the team in executing critical stages of the partnership lifecycle. This includes supporting initial outreach and pitches to potential partners and ensuring the successful execution of contracts, particularly in alignment with annual CMS deadlines, requiring meticulous attention to detail and timely execution.
• • Initially, you will act as a secondary point of contact for our external relationships with preferred providers. As you gain experience and demonstrate success, there will be opportunities to grow into a primary contact role and eventually lead these crucial relationships, fostering strong partnerships and ensuring provider satisfaction.
• • You will be responsible for designing and delivering comprehensive quarterly dashboard reports. These reports will provide clear, concise insights into network performance and key metrics. Additionally, you will develop and execute high-impact newsletter campaigns to keep our stakeholders informed, engaged, and aligned with our strategic objectives.
• • A significant aspect of this role involves close collaboration with cross-functional teams, including Analytics, Customer Success, Clinical Strategy, and Product. This collaboration is essential for refining and defining performance solutions, as well as optimizing internal operations directly associated with the PPN.
• • You will build and maintain robust tracking systems for both leading and lagging success indicators. These systems are vital for monitoring the effectiveness of our initiatives and ensuring that our strategies remain impactful and adaptable as the PPN scales.
• • Furthermore, you will be tasked with mastering and integrating emerging AI tools and technologies. The goal is to enhance team efficiency, drive innovative solutions in network management, and stay at the forefront of technological advancements in healthcare operations.