Provider Network Manager

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.

The Provider Network Manager supports the organization's provider engagement, provider performance improvement, and network oversight activities related to contracted and subcontracted providers. This role is responsible for managing provider relationships, coordinating provider relations initiatives, supporting provider performance monitoring, facilitating communication between providers and internal operational teams, and promoting continuous improvement across the provider network. The Provider Network Manager is accountable for maintaining ongoing engagement with assigned providers, ensuring providers understand organizational expectations, performance standards, compliance requirements, and operational workflows. Through regular provider outreach and onsite visits—with top-performing, high-volume, strategically significant, or priority providers visited at least quarterly—the Manager fosters strong partnerships and drives operational excellence. Utilizing provider scorecards as a key performance management tool, the Manager evaluates provider performance, identifies opportunities for improvement, recognizes excellence, and supports targeted education and training initiatives. Working collaboratively with providers, the Manager develops action plans, addresses performance gaps, resolves operational issues, promotes best practices, and advances quality outcomes, operational efficiency, compliance, and member satisfaction. This position serves as a strategic provider relationship and performance management role focused on engagement, support, education, operational coordination, and continuous improvement rather than sales or purely administrative provider servicing functions.

Minimum Qualifications:

• Bachelor's degree in healthcare administration, business or a related field.
• Requires 3 years of progressive experience in provider relations, healthcare operations, managed care, provider network operations, care coordination, or related healthcare environment.
• Experience supporting provider engagement, provider operations, network management, or provider oversight activities.
• Strong knowledge of healthcare operations, provider network management, healthcare regulations, and provider workflows.
• Strong organizational, problem-solving, and relationship management skills.
• Experience working with healthcare operational data, provider tracking systems, and reporting tools.
• Proficiency with Microsoft Office applications, especially Excel and PowerPoint.
• Excellent communication skills, both written and verbal, with the ability to effectively train and advise staff at all levels.
• Requires strong problem-solving and customer service skills.
• Must be a CA Resident and must reside in CA while employed.
• Current and valid California (CA) Driver's License.
• Must use personal vehicle and current vehicle registration required.
• Proof of auto insurance required, must maintain CA minimum insurance coverage.
• CPR Certification required.

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.