Provider Network Director jobs in Clearwater, FL

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:
Health Plan Provider Network Manager will develop a cohesive, fully engaged prgram that helps the organization achieve its mission and strategic goals. Manages and maintains ongoing relationships, quality, and customer service with existing providers. Responsible for developing the provider network yielding a geographically and cost competitive, high quality, stable network, that meets and exceeds the needs of current and future customers. Ensures adequate, high-quality network coverage. Detects network gaps and/or shortfalls and coordinates recruitment campaigns. Directs and oversees the negotiations of network provider service agreements and single case agreements.Ensures that communication with network facilities and/or providers, is maintained, to encourage quality participation in the BayCare Select network. Responsible for the timely identification and resolution of escalated facility and/or provider issues and/or quality concerns, ensuring follow up plans and interventions are timely and responsive, and supports positive partnerships with BayCare Select clients and network facilities. Responsible for analysis and explanation of contractual guidelines and policies to ensure providers are properly educated on company and client procedures. Responsible for issue resolution as relates to contract performance and/or customer service. Develops and maintains department operational workflows. Overall management of provider contracts, including negotiating and executing contracts and the submission to the outsourced vendor to update the provider data base used to configure pricing for claims payment purposes. Collaborates with Health Plan Leadership on strategy, initiatives and rate structures. Required experience includes 5 years of provider contracting experience within the Medicare plan industry.

Minimum Qualifications:

Location: Park Place

Status: Full Time, Exempt: Yes

Shift Hours: 8:00 AM - 4:30 PM

Shift: Shift 1

Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies

Weekend Work: None

On Call: No

Does this position fall under CMS guidelines for COVID19 vaccine or exemption?: Yes - CMS Requirements Apply

How often will this team member be working remotely? Hybrid

Equal Opportunity Employer Veterans/Disabled