Manager of Provider Network Central Florida

Position Summary

The Manager of Network Central Florida directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Develops, executes, and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Essential Duties And Responsibilities

• Serves as a communication link between providers and the company.
• Serves as a business unit representative on enterprise initiatives around network management and leads projects with significant impact.
• Leads a team of department managers in developing and executing strategic departmental initiatives.
• Maintains a focus on primary care and specialty risk arrangements for Medicaid and Medicare product lines.
• Monitors and analyzes data to develop specific actions to manage medical cost trends.
• Develops best practices to assist risk partners in managing financial risk.
• May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
• Identifies areas to improve provider service levels.
• Edits/enhances relationships within the provider community.
• Manages Network integrity and compliance.
• Manages claims projects as necessary/required.
• Manages provider loads as necessary/required.
• Performs special projects as assigned or directed.
• Prepares financial projections and conducts analysis.

Qualifications And Education

• Requires a Bachelor's Degree in Business, Healthcare or related field.
• Prioritizes 7 years of experience in the healthcare sector (preferably at HMO or PPO).
• At least 5 years of experience in HMO provider/hospital/ancillary contracting and network development.
• At least 3 years of management experience.

Supervisory Responsibility

Yes.

Qualifications And Education

• Required: Bachelor's Degree in Business, Healthcare or related field.
• Preferred: Master's Degree in a related field.
• Candidate Experience Required: 7 years of experience in the healthcare sector (preferably at HMO or PPO).
• 5 years of experience in HMO provider/hospital/ancillary contracting and network development.
• 3 years of management experience.

Specialized Knowledge

• Intermediate Demonstrated leadership skills.
• Disciplined, hands-on and process-oriented leader.
• Advanced Knowledge of regulatory requirements concerning Medicare and Medicaid.
• Advanced Knowledge of provider contracts and health care reimbursement.
• Intermediate Understanding of regulatory compliance management and reporting requirements.
• Ability to manage complex transactions and service models.
• Demonstrated proficiency in establishing and driving medical cost management programs.
• Ability to negotiate effectively with internal/external stakeholders, large hospital and physician healthcare systems.

Working Conditions

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• The noise level in the work environment is usually moderate.
• Works in the field Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.
• This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity.
• The work is performed indoors.
• Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.
• The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds.
• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee is frequently required to stand and walk.
• The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl.
• Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Performance Measurement

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.