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In this role, you will lead and oversee all aspects of provider network management within Florida, ensuring a comprehensive, high-quality, and compliant provider network. You will be responsible for managing a team of provider relations and engagement professionals, driving network development and optimization efforts to meet regulatory requirements and organizational objectives. This includes working closely with healthcare providers to negotiate contracts, resolve disputes, and maintain positive relationships, while ensuring network adequacy and performance meet Medicaid, Medicare, and commercial standards. You will also collaborate with internal teams such as compliance, legal, operations, and analytics to ensure that the network operates efficiently and adheres to all regulatory requirements. Your work will have a direct impact on access to care, provider satisfaction, and the overall quality of services delivered to members.

The Manger of Provider Management will lead a team of provider relations and engagement professionals responsible for maintaining and expanding a comprehensive and compliant network of healthcare providers. This role ensures that the network meets regulatory requirements and provides high-quality, accessible services to members. The Manager will develop strategies to strengthen provider relationships, ensure network adequacy, and drive improvements in network performance.

Functional Competencies:

• Lead and manage the Provider Relations team to ensure effective provider engagement, network maintenance, and compliance with state and federal regulations.
• Oversee provider contracting, credentialing, and network development to ensure a robust, compliant, and geographically accessible network.
• Collaborate with internal teams (compliance, operations, and legal) to monitor network adequacy and address gaps or concerns.
• Serve as the primary point of escalation for provider issues, working closely with the team to resolve concerns related to contracts, service delivery, and claims processing.
• Drive continuous improvement in provider performance, engagement, and satisfaction through regular communications, education, and training.
• Develop and implement strategies to enhance provider satisfaction and retention while ensuring alignment with company goals and compliance standards.
• Work with analytics teams to regularly evaluate network performance, identifying areas for improvement and working with providers to meet key performance indicators (KPIs).
• Ensure the provider network is fully compliant with all contractual and regulatory requirements, including state-specific Medicaid standards and Medicare Advantage guidelines.
• Oversee provider onboarding processes, ensuring that new providers are integrated into the network smoothly and efficiently.
• Act as a strategic partner in new business development, offering insights into provider network opportunities and risks.
• Maintain an in-depth understanding of Florida Medicaid and Medicare programs, regulations, and policy changes to anticipate and address provider network needs.

Core Competencies:

• Leadership: Proven ability to lead, mentor, and inspire a team, fostering a collaborative and high-performing work environment.
• Strategic Thinking: Ability to develop and execute strategic plans to enhance provider networks and align with organizational goals.
• Compliance and Regulatory Knowledge: Deep understanding of Medicaid, Medicare, and other relevant healthcare regulations, with the ability to ensure compliance in network operations.
• Communication: Strong interpersonal and communication skills for engaging with providers, internal teams, and external stakeholders at all levels.
• Problem Solving: Aptitude for analyzing complex issues, identifying root causes, and implementing effective solutions.
• Negotiation: Skilled in contract negotiation, with the ability to build mutually beneficial relationships with providers and resolve conflicts efficiently.

Behavioral Competencies:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. 
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members