Sr. Provider Relations Representative

Sr. Provider Relations Representative

Miami Lakes, FL 33016; Miami, FL 33126

Description

At Claremedica, exceptional is the standard. Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we're working together to help seniors live happier, healthier, fuller lives. That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees' growth and wellness and where their full potential and value are realized. At Claremedica, we're excited about great people like you. We're even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities. Opportunity awaits – welcome to Claremedica.

Essential Functions

The Senior Provider Relations Representative is responsible for managing and strengthening strategic relationships across ClareMedica's specialty and ancillary provider network. This role serves as a key liaison between ClareMedica and high-profile provider partners, including large multi-specialty physician groups, ancillary facilities, ambulatory surgery centers (ASCs), imaging centers, diagnostic facilities, and other contracted network providers. The Sr. Provider Relations Representative plays a critical role in supporting network integrity, provider performance, operational alignment, referral management initiatives, and overall provider satisfaction. This position requires a high level of professionalism, relationship management, operational oversight, and the ability to navigate complex provider issues across multiple markets.

Duties and Responsibilities

• Develop, manage, and maintain strategic relationships with high-volume specialty groups, ancillary providers, ASCs, imaging centers, diagnostic facilities, and physician organizations
• Serve as the primary point of contact for escalated provider operational concerns, network issues, and service-related matters
• Support provider onboarding, orientation, and ongoing education related to ClareMedica processes, referral workflows, policies, and operational initiatives
• Coordinate closely with internal operational, contracting, credentialing, referral management, and clinical leadership teams to ensure provider alignment and network performance
• Assist in the implementation and oversight of specialty network initiatives focused on network fidelity, access, utilization management, and provider engagement
• Monitor provider performance trends, referral patterns, access concerns, and operational compliance issues and escalate findings as appropriate
• Maintain accurate provider records, network data, and provider documentation within applicable systems and databases
• Coordinate provider meetings, site visits, and relationship management activities across assigned markets
• Support issue resolution involving scheduling, eligibility, referrals, credentialing, claims, provider data, and operational workflows
• Assist with provider audits, recredentialing activities, and network reporting initiatives
• Collaborate with leadership on strategic provider partnership development and network expansion opportunities
• Support communication and coordination related to in-house specialist scheduling and ancillary service alignment
• Represent ClareMedica professionally in provider-facing meetings and regional market interactions

Supervisory Responsibilities

• This position does not have direct supervisory responsibilities but is expected to operate with a high degree of independence and leadership within assigned markets and provider relationships.

Qualifications

Qualifications/Requirements

• Bachelor's degree
• Minimum 5+ years of provider relations, healthcare network operations, managed care, or related healthcare experience
• Experience managing relationships with specialty physician groups, ancillary providers, ASCs, diagnostic facilities, and/or multi-site healthcare organizations strongly preferred
• Must speak English & Spanish fluently
• Strong understanding of healthcare operations, managed care, referral workflows, and provider network management
• Excellent communication, presentation, organizational, and relationship management skills
• Ability to manage multiple priorities and work effectively in a fast-paced environment
• Strong problem-solving skills with the ability to independently manage escalated provider issues
• Proficient in Microsoft Office and healthcare systems/platforms

Working Conditions

General office working conditions with regular provider office and facility visits.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

While performing the duties of this job, the employee will be required to stand, walk, sit, use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust your focus. Manual dexterity is required to use desktop computers and peripherals.

Work Environment

The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Travel

Regular local travel between care centers and provider offices is required. Monthly travel to Central Florida markets, including Orlando and Tampa, is required for provider relationship management, operational oversight, and partnership development activities.

Safety Hazard of the Job

Minimal Hazards

This job description does not list all the duties and responsibilities of the job. You may be asked by supervisors or managers to perform other instructions, duties, and responsibilities, as appropriate. You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management has the right to revise this job description at any time. The job description is not a contract for employment, and either you or the employer may terminate employment at any time, with or without cause, with or without notice.