Especialista De Redes VIP

MCS Health; San Juan (PR); On-site; USD 65,000 - 85,000; Full time

Job summary

MCS Healthcare Holdings, LLC (MCS) seeks a Network Specialist to build and maintain strong relationships with network providers and their staff in Puerto Rico. You will analyze pharmacy reports, coordinate meetings, and deliver actionable insights to improve network performance.

Responsibilities include scheduling visits, supporting compliance initiatives, and documenting activities in the CRM system to monitor engagement and outcomes.

Qualifications

• Bachelor’s degree in Business Administration or related field.
• At least three years of provider service, relationship management, and report analysis.
• Proven ability to coordinate meetings and manage communications.

Responsibilities

• Develop and maintain relationships with providers and medical staff.
• Review pharmacy reports to support prescribing practices and objectives.
• Coordinate weekly provider visit schedules and track attendance.
• Document visits and activities in the CRM system accurately.
• Support compliance projects and educational initiatives.

Skills

Provider relations

Data analysis

CRM management

Meeting coordination

Education

Bachelor’s degree in Business Administration

Tools

CRM system

Reporting tools

Job description

The VIP Network Specialist is responsible for developing lasting relationships with providers, specialists, and their office staff, bringing clinical project information, and identifying and addressing situations between the insurer and the provider. Creates communication links between specialists and primary care physicians by coordinating meetings and delivering the primary provider directory. Ensures improvement in medical utilization of providers assigned to their region by delivering and discussing reports and metrics.

ESSENTIAL FUNCTIONS:

• Conduct quarterly strategic visits with network specialists to strengthen provider relationships, promote engagement, and identify opportunities to enhance network performance.
• Review and analyze pharmacy reports with assigned providers to identify opportunities and support prescribing practices aligned with organizational strategies and clinical objectives.
• Develops, coordinates, and submits a weekly provider visit schedule to the supervisor, ensuring appropriate planning, prioritization, and execution of provider engagement activities.
• Establishes and maintains strong professional relationships with providers and medical office staff to improve access, strengthen engagement, and increase participation in educational programs and initiatives.
• Support pharmacy strategies, including Academic Detailing and Preferred Drug List development as well as special projects assigned to the unit.
• Analyzes utilization reports by supporting the Dashboard Metrics project. Discussed relevant findings, trends, and opportunities for improvement with assigned specialist providers. Reach 100% of visits by the end of the year.
• Provides ongoing support to the Concierge Service Unit, facilitating coordination and resolution of medical appointments.
• Support MCS compliance projects such as RADV and STARS.
• Coordinates provider meetings and activities, including invitations, follow-up communications, reminders, and other logistical efforts, to achieve at least 90% attendance among invited participants.
• Accurately documents providers' visits and related activities in the CRM system on a timely basis and complete all required reports and documentation used to monitor performance and providers' engagement.

ADDITIONAL FUNCTIONS:

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience:

Bachelor’s degree, preferably in Business Administration. At least three (3) years of experience in providing service to providers, medical staff, relationship management, and analyzing reports.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses:

A Driver's License valid in the Commonwealth of Puerto Rico is required.

Languages:

• Spanish – Advanced (comprehensive, writing and verbal)
• English – Advanced (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Aff…

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take Aff…