Network Relations Manager – Florida

About the role

This role designs, develops, contracts, maintains, and enhances relationships with facilities, physicians, and ancillary providers serving as contractual networks of care for members. It involves managing and maintaining these relationships, analyzing provider performance, addressing escalated issues, and collaborating with various internal and external stakeholders.

Responsibilities

• Designs, develops, contracts, maintains, and enhances relationships with facilities, physicians, and ancillary providers serving as contractual networks of care for members.
• Maintains relationships with healthcare providers within a network by negotiating contracts, evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.
• Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
• Analyzes network provider performance and quality indicators, conducting regular assessments and audits to ensure compliance with contractual obligations and service level agreements.
• Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
• Negotiates and establishes contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
• Develops tactical and operational plans to expand and enhance the network, working closely with business development teams to identify and onboard new providers in strategic areas.
• Maintains and monitors network data, including provider demographics and network adequacy metrics, to assess the effectiveness and efficiency of the network and make recommendations for improvements.
• Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
• Conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
• Stays updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicates relevant information to internal stakeholders.

Requirements

• Minimum of 5 years’ experience in provider relations, network management, healthcare contracting, or payer operations.
• At least 3 years of experience within a Managed Care environment, supporting providers with contracting and contract management.
• Strong working knowledge of healthcare business segments, products, and industry terminology.
• Demonstrated problem-solving and decision-making skills.
• Proven ability to collaborate cross-functionally to support provider network management initiatives.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook).
• Resides in the state of Florida.