Data Network Manager Jobs in Florida (NOW HIRING)

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Position Summary

This is an individual contributor role.

The Manager, Network Relations role is critical in advancing the organization's Value-Based Contracting (VBC) strategy for the Rest of FL Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and overall VBC strategies within the state.

What you will do

• Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
• Analyzes network provider performance and quality indicators, conducting regular assessments and audits to ensure compliance with contractual obligations and service level agreements.
• Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
• Collaborates with network contracting teams to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
• Develop tactical and operational plans to expand and enhance the network, working closely with business development teams to identify and onboard new providers in strategic areas.
• Monitors and analyzes network data, including provider demographics and network adequacy metrics, to assess the effectiveness and efficiency of the network and make recommendations for improvements.
• Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
• conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
• Stay updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicate relevant information to internal stakeholders.

Required Qualifications

• Minimum 7 years of experience in healthcare quality, risk adjustment, or compliance within a Medicare Advantage setting.
• Minimum 5 years of experience in provider relationship management, network management, or provider services within a healthcare environment.
• Strong understanding of CMS regulations, HEDIS, STAR ratings, and provider engagement strategies.
• Demonstrated ability to analyze financial and quality performance data and implement process improvements.
• Must reside within the Florida market, with a preference for candidates located in the Jacksonville or Orlando areas.

Preferred Qualifications

• Experience with Commercial and Medicare lines of business.
• Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.
• Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

Education

• Bachelor's degree preferred or a combination of professional work experience and education.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.