Provider Network Manager

We are seeking a Provider Network Manager 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:

Minimum Qualifications:

Preferred Qualifications:

• 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 (e.g., CPHQ, CPMSM).
• Demonstrated success in managing large or complex provider networks.

Responsibilities:

• Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
• Support the implementation, management, and continuous improvement of provider engagement, provider performance, and provider satisfaction initiatives to strengthen provider partnerships and support organizational goals.
• Serve as the primary liaison between the organization and contracted providers regarding operational processes, performance expectations, service delivery requirements, and issue resolution.
• Coordinate provider onboarding, orientation, training, and ongoing education activities to ensure understanding of organizational requirements, workflows, documentation standards, compliance expectations, and performance objectives.
• Facilitate timely resolution of provider inquiries, complaints, service concerns, and operational issues, including tracking escalations, action plans, and resolution 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 internal departments, including Operations, Quality, Compliance, Credentialing, Care Management, Claims, and Provider Network teams, to support effective provider operations and service delivery.
• Monitor, analyze, and maintain provider-related operational data, performance metrics, engagement activities, and trend reports to support decision-making and performance improvement efforts.
• Assist in the preparation and support of provider audits, delegated oversight activities, compliance reviews, corrective action plans, and operational improvement initiatives in accordance with applicable regulatory and contractual requirements.
• Participate in the development, implementation, and revision of provider-related workflows, policies, procedures, operational documentation, and process improvement initiatives to enhance efficiency and effectiveness.
• Promote a culture of collaboration, accountability, continuous improvement, and member-centered service by fostering positive provider relationships and supporting organizational and provider network objectives.
• Performs other duties as required or assigned.