PROVIDER NETWORK MANAGER - SPECIALTY NETWORK

Job DescriptionJob DescriptionPosition Type: Full-Time Market Requirement:Candidates must reside locally within the Central Florida market, specifically the Orlando and/or Tampa market areas.POSITION SUMMARYThe 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 RESPONSIBILITIESSpecialty Network Development & ContractingDevelop 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 ManagementServe 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 ResolutionResearch 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 & PerformanceMonitor 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.Internal CollaborationWork collaboratively with Provider Network leadership and cross-functional departments to support organizational and market objectives.Partner with Credentialing to facilitate timely completion of provider credentialing requirements.Collaborate with Utilization Management to address specialty access needs and provider-related authorization or referral concerns.Coordinate with Claims and Provider Operations regarding provider payment or operational issues.Support Sales, Enrollment, and other departments by helping ensure the availability of an adequate and competitive provider network.Communicate significant provider developments, market intelligence, competitive activity, and network concerns to leadership.Participate in departmental meetings, market strategy discussions, and special projects as assigned.QUALIFICATIONSRequired QualificationsBachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field preferred. Equivalent relevant healthcare experience may be considered.Minimum of 3–5 years of experience in provider relations, provider contracting, network development, managed care, health plan operations, or a related healthcare field.Experience working with physician practices, specialty providers, medical groups, ancillary providers, or healthcare organizations.Working knowledge of managed care and health plan operations.Understanding of provider contracting, credentialing, claims, authorizations, referrals, and provider network operations.Strong relationship-building, negotiation, communication, and problem-solving skills.Ability to manage multiple provider relationships, priorities, projects, and deadlines simultaneously.Strong organizational skills with demonstrated attention to detail and follow-through.Ability to work independently and exercise sound judgment while collaborating effectively as part of a team.Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.Ability and willingness to travel regularly throughout the assigned Central Florida territory.Valid Florida driver's license and reliable transportation for provider visits and other business-related travel.Must reside locally within the Orlando and/or Tampa market.Preferred QualificationsExperience working for a Medicare Advantage health plan, managed care organization, IPA, MSO, or similar healthcare organization.Previous experience developing or managing a specialty physician network.Existing professional relationships with specialty providers and medical groups within the Orlando and/or Tampa healthcare markets.Experience negotiating physician, ancillary, or provider group agreements.Knowledge of CMS requirements and Medicare Advantage provider network standards.Experience with provider network adequacy and provider access requirements.Familiarity with value-based care arrangements and provider performance initiatives.Experience working with provider databases, CRM systems, contract management systems, or other healthcare network management platforms.Bilingual English/Spanish is a plus.KNOWLEDGE, SKILLS & ABILITIESThe successful candidate should demonstrate:Excellent interpersonal and relationship-management skills.Strong provider-facing communication and presentation abilities.Effective negotiation and influencing skills.Ability to establish credibility with physicians, practice administrators, and healthcare executives.Strong analytical and problem-solving capabilities.Ability to research complex provider issues and coordinate solutions across multiple departments.Strong sense of accountability and ownership.Ability to prioritize effectively in a fast-paced, growing organization.Knowledge of the Central Florida healthcare landscape and provider community.Ability to balance provider satisfaction with organizational, contractual, regulatory, and operational requirements.Professional judgment and discretion when handling confidential or sensitive provider and company information.WORK ENVIRONMENT & TRAVELThis is a market-facing position requiring regular interaction with providers throughout the assigned territory. The Provider Network Manager will work both remotely and in the field and must be available to conduct in-person provider meetings, office visits, presentations, and other business activities throughout the Orlando and/or Tampa market.Regular local travel is required. Occasional travel to other Solis Health Plans locations or markets may also be necessary based on business needs.OUR IDEAL CANDIDATEOur ideal Provider Network Manager is a relationship-driven healthcare professional who understands that successful provider network management goes beyond executing contracts. This individual develops trusted relationships with providers, understands the needs of the local healthcare community, identifies opportunities for network growth, and works collaboratively to resolve issues.The successful candidate will be comfortable being the face of Solis Health Plans within the specialty provider community and will take ownership of developing and maintaining a strong, accessible, and responsive provider network that supports both our members and our providers.