Senior Managed Care Network Manager

Our Promise To You Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by extending the healing ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose‑minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403‑B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well‑being Resources Mental Health Resources and Support Pet Benefits Schedule Full time Shift Day (United States of America) Address

2600 LUCIEN WAY

City

MAITLAND

State Florida Postal Code 32751 Job Description Implements managed care plans by coordinating with internal and external stakeholders. Leads/facilitates acquired/affiliated provider group transitions. Develops strong relationships with plans through regular communication and collaboration. Negotiates contract terms and amendments with managed care plans to secure favorable agreements. Monitors and assesses the performance of managed care plans to ensure compliance and effectiveness. Provides ongoing support and resolution of escalated issues and claims payment projects related to managed care plans. Coordinates as appropriate with credentialing processes for acquired and affiliated groups providers within managed care networks. Facilitates training and education for provider group leaders on managed care policies and procedures. Collaborates with managed care plans to address and resolve any escalated operational, claim, or clinical concerns. Ensures continuous improvement in managed care plan operations through strategic initiatives. Reviews and evaluates managed care plan proposals to ensure alignment with organizational goals and objectives. Performs other duties assigned. Knowledge, Skills, And Abilities Familiar with a variety of the field's concepts, practices, and procedures. Knowledge of medical terminology, CPT‑coding, and reimbursement mechanisms. [Required] Effective verbal/written interpersonal/communication skills. Must be able to communicate effectively with the PHO/Hospital Medical Staff, Hospital Administration and departments. [Required] Ability to work independently, planning, organizing, and prioritizing duties. Must be able to manage variable work schedule and attend early morning and evening meetings if required. [Required] Excellent organizational and computer skills including proficiency in MS Office suite software, including Microsoft Access. [Required] Reasoning ability, language skills, and mathematical skills. [Required] Education Bachelor's [Required] Masters [Preferred] Field Of Study Bachelor's in Healthcare, Business or related field. Work Experience 7+ years of experience in healthcare or insurance [Required] 5+ years training or experience in contract negotiations and/or contract administration and implementation [Preferred] Direct experience with provider relations, network management, provider contract negotiation, and/or implementation [Required] Additional Information An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement: Bachelor’s degree AND 7+ years of experience OR Associates degree AND 9+ years of experience OR High School Grad or Equivalent AND 11+ years of experience. Licenses And Certifications N/A Physical Requirements Physical Requirements - Pay Range $66,170.74 - $123,073.07 Background Screening Requirement (Florida Law) Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at: This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. #J-18808-Ljbffr AdventHealth