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POSITION SUMMARY

The Provider Network Manager - Specialty Network is responsible for developing, maintaining, and strengthening Solis Health Plans' specialty provider network throughout the assigned Central Florida market. This position serves as a primary liaison between Solis Health Plans and contracted and prospective specialty providers, physician groups, ancillary providers, and other healthcare organizations. The Provider Network Manager is responsible for identifying network needs, recruiting and contracting providers, developing strong provider relationships, supporting network adequacy, educating provider offices, and facilitating the resolution of operational issues. The ideal candidate is an experienced healthcare professional with strong knowledge of Medicare Advantage, provider contracting, provider relations, and the Central Florida healthcare market. This individual should possess established relationships within the provider community and be comfortable working independently in a field-based environment while collaborating closely with internal departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Specialty Network Development & Contracting Develop and maintain a comprehensive specialty provider network within the assigned Orlando and/or Tampa market. Identify specialty network needs and actively recruit physicians, physician groups, ancillary providers, and other healthcare entities to support network growth and adequacy. Initiate and manage provider contracting activities from initial outreach through contract execution and implementation. Negotiate provider agreements within established company guidelines and approved reimbursement parameters. Develop and maintain relationships with key specialty practices, medical groups, healthcare organizations, and provider leadership throughout the assigned territory. Maintain an active pipeline of prospective providers and strategically prioritize recruitment based on specialty, geographic need, membership growth, access requirements, and network adequacy. Assist in identifying gaps in the provider network and develop strategies to address identified deficiencies. Coordinate with Credentialing, Contracting, Provider Operations, and other departments to facilitate timely provider onboarding and activation. Provider Relationship Management Serve as a primary point of contact for assigned specialty providers and provider groups. Establish strong, professional, and collaborative relationships with physicians, practice administrators, office managers, and other key provider contacts. Conduct regular provider visits and maintain an appropriate field presence throughout the assigned market. Proactively engage providers to identify concerns, improve satisfaction, and strengthen their relationship with Solis Health Plans. Educate providers and office staff regarding Solis policies, procedures, operational requirements, available resources, and applicable health plan processes. Facilitate communication between providers and internal departments when issues require additional research or resolution. Maintain consistent follow-up with providers and ensure outstanding matters are appropriately tracked through resolution. Provider Issue Resolution Research and facilitate resolution of provider inquiries and escalations involving claims, authorizations, referrals, credentialing, contracting, provider data, network participation, and other operational matters. Coordinate with Claims, Utilization Management, Credentialing, Member Services, Finance, and other internal departments to resolve provider concerns. Identify recurring provider issues and escalate trends that may indicate broader operational or process concerns. Maintain ownership of provider issues through resolution and communicate status and outcomes to provider offices as appropriate. Assist providers in understanding health plan processes and direct them to appropriate resources when necessary. Network Management & Performance Monitor assigned network for adequacy, accessibility, geographic coverage, specialty availability, and emerging provider needs. Support initiatives designed to improve provider engagement, network performance, quality, and member access to care. Review provider network data and reports to identify opportunities for network development and improvement. Maintain accurate documentation of provider contacts, visits, recruitment activities, contracting status, and outstanding issues within designated company systems. Prepare and provide routine updates regarding provider recruitment, contracting activity, network development, provider issues, and market activity. Participate in provider meetings, orientations, educational sessions, and other provider-facing initiatives. Monitor healthcare market developments and maintain awareness of key provider organizations and specialty groups within the assigned territory.

Pay:

$70,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Referral program Vision insurance

Work Location:

On the road