Sr. Provider Relations Representative

Sr. Provider Relations Representative

Miami Lakes, FL 33016;
Miami, FL 33126

At Claremedica, exceptional is the standard. Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we're working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees' growth and wellness and where their full potential and value are realized. At Claremedica, we're excited about great people like you. We're even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to Claremedica.

Essential Functions

The Senior Provider Relations Representative is responsible for managing and strengthening strategic relationships across Clare Medica's specialty and ancillary provider network. This role serves as a key liaison between Clare Medica and high-profile provider partners, including large multi-specialty physician groups, ancillary facilities, ambulatory surgery centers (ASCs), imaging centers, diagnostic facilities, and other contracted network providers. The Sr. Provider Relations Representative plays a critical role in supporting network integrity, provider performance, operational alignment, referral management initiatives, and overall provider satisfaction.

This position requires a high level of professionalism, relationship management, operational oversight, and the ability to navigate complex provider issues across multiple markets.

Duties and Responsibilities

• Develop, manage, and maintain strategic relationships with high-volume specialty groups, ancillary providers, ASCs, imaging centers, diagnostic facilities, and physician organizations
• Serve as the primary point of contact for escalated provider operational concerns, network issues, and service-related matters
• Support provider onboarding, orientation, and ongoing education related to Clare Medica processes, referral workflows, policies, and operational initiatives
• Coordinate closely with internal operational, contracting, credentialing, referral management, and clinical leadership teams to ensure provider alignment and network performance
• Assist in the implementation and oversight of specialty network initiatives focused on network fidelity, access, utilization management, and provider engagement
• Monitor provider performance trends, referral patterns, access concerns, and operational compliance issues and escalate findings as appropriate
• Maintain accurate provider records, network data, and provider documentation within applicable systems and databases
• Coordinate provider meetings, site visits, and relationship management activities across assigned markets
• Support issue resolution involving scheduling, eligibility, referrals, credentialing, claims, provider data, and operational workflows
• Assist with provider audits, recredentialing activities, and network reporting initiatives
• Collaborate with leadership on strategic provider partnership development and network expansion opportunities
• Support communication and coordination related to in-house specialist scheduling and ancillary service alignment
• Represent Clare Medica professionally in provider-facing meetings and regional market interactions

Supervisory Responsibilities

• This position does not have direct supervisory responsibilities but is expected to operate with a high degree of independence and leadership within assigned markets and provider relationships.

Qualifications/Requirements

• Bachelor's degree
• Minimum 5+ years of provider relations, healthcare network operations, managed care, or related healthcare experience
• Experience managing relationships with specialty physician groups, ancillary providers, ASCs, diagnostic facilities, and/or multi-site healthcare organizations strongly preferred
• Must speak English & Spanish…