Manager, Provider Network Operations
7 days ago
We are seeking a Manager, Provider Network Operations to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Manager of Provider Network Operations plays a critical leadership role in overseeing the development, maintenance, and optimization of the healthcare provider network to ensure high-quality, cost-effective care delivery. This position is responsible for managing relationships with healthcare providers, negotiating contracts, and ensuring compliance with regulatory requirements and organizational standards. The role requires strategic planning to expand and enhance the provider network, aligning with the company's goals and member needs. The manager will lead a team focused on operational excellence, data analysis, and process improvement to drive network performance and provider satisfaction. Ultimately, this role ensures that members have access to a comprehensive, efficient, and high-performing provider network that supports positive health outcomes and organizational success.
Minimum Qualifications:
- Bachelor's degree in Healthcare Administration, Business, or a related field.
- Minimum of 5 years of experience in healthcare provider network management or operations.
- Proven experience managing provider contracts and relationships within a managed care or health plan environment.
- Strong knowledge of healthcare regulations, including network adequacy standards and compliance requirements.
- Demonstrated leadership skills with experience managing teams and driving operational improvements.
Preferred Qualifications:
- Master's degree in Healthcare Administration, Business Administration, or a related discipline.
- Experience with provider network management software and data analytics tools.
- Familiarity with value-based care models and population health management.
- Certification in healthcare management or related professional credentials (e.g., CPHQ, CPMSM).
- Experience working in a large, multi-state health plan or integrated delivery system.
Responsibilities:
- Lead and manage the day-to-day operations of the provider network team, ensuring effective provider relations and network adequacy.
- Develop and implement strategies for provider recruitment, retention, and engagement to maintain a robust and diverse network.
- Negotiate and manage provider contracts, ensuring terms align with organizational goals and regulatory requirements.
- Monitor network performance metrics and compliance standards, identifying opportunities for improvement and implementing corrective actions.
- Collaborate cross-functionally with clinical, claims, and compliance teams to support integrated network operations and member services.
- Oversee provider data management, ensuring accuracy and timely updates to support network analytics and reporting.
- Lead initiatives to enhance provider satisfaction and resolve operational issues promptly and effectively.
- Ensure adherence to all applicable healthcare laws, regulations, and accreditation standards related to provider network operations.
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