Manager of Provider Network Central Florida

Solis Health Plans, Inc.; Orlando (FL); On-site; USD 100,000 - 170,000; Full time

Job summary

Solis Health Plans, Inc. in Orlando, FL oversees network development for Medicaid/Medicare products and collaborates with medical management and sales to drive market growth and cost targets.

As Manager of Network Central Florida, you direct provider relationships, ensure regulatory compliance, and mentor a team while guiding financial risk and provider costs.

Qualifications

• Bachelor's degree in Business, Healthcare or related field.
• 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.

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.
• Monitors primary care and specialty risk arrangements for Medicaid and Medicare product lines.
• Performs data analysis and develops specific actions to manage medical cost trends.
• Develops best practice 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.
• Educates/enhances relationships within the provider community.
• Manages Network integrity and compliance.
• Manages claims projects as necessary/required.
• Manages provider loads as necessary/required.
• Special projects as assigned or directed.
• Prepares financial projections and conducts analysis.

Education

Bachelor's Degree in Business, Healthcare or related field

Master's Degree in related field (preferred)

Job description

• Candidates must live in Orlando or Tampa area to be considered**

• Candidates must live in Orlando or Tampa area to be considered**

Position Summary

The Manger of Network Central Florida directs and develops a healthcare provider network. Designs and administer 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

To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation, including, but not limited to:

Key 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.
• Monitors primary care and specialty risk arrangements for Medicaid and Medicare product lines.
• Performs data analysis and develops specific actions to manage medical cost trends.
• Develops best practice 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.
• Educates/enhances relationships within the provider community.
• Manages Network integrity and compliance.
• Manages claims projects as necessary/required.
• Manages provider loads as necessary/required.
• Special projects as assigned or directed.
• Prepares financial projections and conducts analysis.

SUPERVISORY RESPONSIBILITY

• Yes.

Qualifications And Education

Required Qualifications

• Requires a Bachelor's Degree in Business, Healthcare or related field.
• Preferred A 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.

Preferred Qualifications

• Intermediate Demonstrated leadership skills Disciplined, hands-on and process-oriented leader.
• Advanced Other Knowledge of regulatory requirements concerning Medicare and Medicaid.
• Advanced Other Knowledge of provider contracts and health care reimbursement.
• Intermediate Other 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. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• 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. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

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 MEASUREMENTS

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

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.

Employee Acknowledgement

I have read this job description and understand what is expected of me while I occupy this role.