Provider Network Manager – Specialty Network

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Doral, FL, US

Salary: $70,000.00 Annually

Position Type: Full-Time
Market Requirement:Candidates must reside locally within the Central Florida market, specifically the Orlando and/or Tampa market areas.

POSITION SUMMARY

The 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.

• Develop 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.

• Serve 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.
• Research and facilitate resolution of provider inquiries and escalations involving claims, authorizations, referrals, credentialing, contracting,…