PROVIDER NETWORK MANAGER manages the operations of a healthcare provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a PROVIDER NETWORK MANAGER recruits, hires, trains, and measures performance of staff to provide effective and operations within budget. May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, PROVIDER NETWORK MANAGER requires a bachelor's degree. Typically reports to top management. The PROVIDER NETWORK MANAGER typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a PROVIDER NETWORK MANAGER typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
This position serves the West Central Florida (Sarasota Manatee counties) you must be based in that area. 50% local travel to visit current and potential network providers will be required. Out of state candidates will not be considered.
Ultimate Health Plans, Inc. (“UHP”) is a fast growing Medicare Advantage health plan with its headquarters located in Spring Hill, Florida. UHP plans provide all the benefits of Original Medicare Parts A and B, plus additional benefits not available with Original Medicare.
We are looking for someone who has worked for a health plan, negotiated contracts, and managed provider relationships. You need to understand Medicare Advantage guidelines and protocols.
Provider Network Manager acts as liaison between providers and the Health Plan to enhance the business relationship. Representative will perform new provider orientations, conduct regular provider visits to address service issues, as well as perform educational outreach with a focus on improving the provider’s quality metrics.
Primary duties may include but are not limited to:
Education/Experience requirements:
Requires a High School Diploma/GED and 3 years of customer service experience; preferably in a health care or insurance environment. Requires strong oral, written and interpersonal communication skills, problem-solving and presenting skills. Any combination of education and experience, which would provide an equivalent background.
Other requirements:
Must have current driver’s license and insurance; willing to travel to offices in assigned territory 80% or more.
Job Type: Full-time
Pay: $65,000.00 - $71,000.00 per year
Benefits:
Schedule:
Experience:
Willingness to travel:
Work Location: On the road