Senior Managed Care Network Manager

Job Description

Implements managed care plans by coordinating with internal and external stakeholders. Leads/facilitates acquired/affiliated provider group transitions. Develops strong relationships with plans through regular communication and collaboration. Negotiates contract terms and amendments with managed care plans to secure favorable agreements. Monitors and assesses the performance of managed care plans to ensure compliance and effectiveness.

Provides ongoing support and resolution of escalated issues and claims payment projects related to managed care plans. Coordinates as appropriate with credentialing processes for acquired and affiliated groups providers within managed care networks. Facilitates training and education for provider group leaders on managed care policies and procedures. Collaborates with managed care plans to address and resolve any escalated operational, claim, or clinical concerns. Ensures continuous improvement in managed care plan operations through strategic initiatives. Reviews and evaluates managed care plan proposals to ensure alignment with organizational goals and objectives.

Knowledge, Skills, And Abilities

• Familiar with a variety of the field's concepts, practices, and procedures.
• Knowledge of medical terminology, CPT-coding, and reimbursement mechanisms.
• [Required] Effective verbal/written interpersonal/communication skills. Must be able to communicate effectively with the PHO/Hospital Medical Staff, Hospital Administration and departments.
• [Required] Ability to work independently, planning, organizing, and prioritizing duties. Must be able to manage variable work schedule and attend early morning and evening meetings if required.
• [Required] Excellent organizational and computer skills including proficiency in MS Office suite software, including Microsoft Access.
• [Required] Reasoning ability, language skills, and mathematical skills.

Education

• Bachelor's [Required]
• Masters [Preferred]
• Field Of Study Bachelor's in Healthcare, Business or related field.

Work Experience

• 7+ of experience in healthcare or insurance [Required]
• 5+ years training or experience in contract negotiations and/or contract administration and implementation [Preferred]
• Direct experience with provider relations, network management, provider contract negotiation, and/or implementation [Required]

Additional Information

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Bachelor’s degree AND 7+ years of experience OR Associates degree AND 9+ years of experience OR High School Grad or Equivalent AND 11+ years of experience.
• Licenses And Certifications N/A

Physical Requirements

View physical requirements

Pay Range

$66,170.74 - $123,073.07

Background Screening Requirement

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/. This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.