Manager of Network Central Florida

Solis Health Plans

3d•Onsite

About The Position

The Manager of Network Central Florida directs and develops a healthcare provider network. Designs and administers 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.

Requirements

Requires a 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.

Nice To Haves

Preferred A Master's Degree in a related field.
Demonstrated leadership skills
Disciplined, hands-on and process-oriented leader.
Knowledge of regulatory requirements concerning Medicare and Medicaid.
Knowledge of provider contracts and health care reimbursement.
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.

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.