Provider Network Manager
About The Position
Independent Living Systems (ILS), together with affiliated health plans Florida Community Care and Florida Complete Care, seeks a Provider Network Manager to support provider engagement, performance improvement, and network oversight for contracted and subcontracted providers. The role manages provider relationships, coordinates provider relations initiatives, supports performance monitoring, facilitates communication between providers and internal operational teams, and promotes continuous improvement across the provider network. The Manager maintains ongoing engagement with assigned providers and ensures they understand organizational expectations, performance standards, compliance requirements, and operational workflows. Regular outreach and onsite visits are expected, with top-performing, high-volume, strategically significant, or priority providers visited at least quarterly. Using provider scorecards, the Manager evaluates performance, identifies improvement opportunities, recognizes excellence, and supports education and training. In partnership with providers, the Manager develops action plans, addresses performance gaps, resolves operational issues, promotes best practices, and advances quality outcomes, operational efficiency, compliance, and member satisfaction. This is a strategic provider relationship and performance management role focused on engagement, support, education, operational coordination, and continuous improvement rather than sales or purely administrative provider servicing.
Requirements
- Bachelor’s degree in healthcare administration, business, or a related field.
- At least 3 years of progressive experience in provider relations, healthcare operations, managed care, provider network operations, care coordination, or a related healthcare environment.
- Experience supporting provider engagement, provider operations, network management, or provider oversight activities.
- Strong knowledge of healthcare operations, provider network management, healthcare regulations, and provider workflows.
- Strong organizational, problem-solving, customer service, and relationship management skills.
- Experience working with healthcare operational data, provider tracking systems, and reporting tools.
- Proficiency with Microsoft Office applications, especially Excel and PowerPoint.
- Excellent written and verbal communication skills, including the ability to train and advise staff at all levels.
- Must be a California resident and reside in California while employed.
- Current and valid California driver’s license.
- Must use a personal vehicle and maintain current vehicle registration.
- Proof of auto insurance and maintenance of California minimum insurance coverage required.
- CPR certification required.
Nice To Haves
- Master’s degree in Healthcare Administration, Business Administration, or a related discipline.
- Experience working within managed care organizations or health insurance companies.
- Familiarity with healthcare compliance standards such as HIPAA and CMS regulations.
- Certification in healthcare management or provider network contracting, such as CPHQ or CPMSM.
- Demonstrated success managing large or complex provider networks.
Responsibilities
- Demonstrate commitment to the organization’s mission and model ILS Experience Standards of Excellence.
- Support the implementation, management, and continuous improvement of provider engagement, performance, and satisfaction initiatives.
- Serve as the primary liaison between the organization and contracted providers on operational processes, performance expectations, service delivery requirements, and issue resolution.
- Coordinate provider onboarding, orientation, training, and ongoing education on organizational requirements, workflows, documentation standards, compliance expectations, and performance objectives.
- Resolve provider inquiries, complaints, service concerns, and operational issues in a timely manner, tracking escalations, action plans, and outcomes.
- Develop, maintain, and distribute provider communications, educational materials, operational resources, and provider-facing tools related to policy updates, program requirements, and organizational initiatives.
- Collaborate with Operations, Quality, Compliance, Credentialing, Care Management, Claims, and Provider Network teams to support provider operations and service delivery.
- Monitor, analyze, and maintain provider operational data, performance metrics, engagement activities, and trend reports to support decisions and performance improvement.
- Assist with provider audits, delegated oversight, compliance reviews, corrective action plans, and operational improvement initiatives in accordance with regulatory and contractual requirements.
- Participate in developing, implementing, and revising provider workflows, policies, procedures, operational documentation, and process improvement initiatives.
- Promote collaboration, accountability, continuous improvement, and member-centered service through positive provider relationships and support for organizational and network objectives.
- Perform other duties as required or assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
