Network Operations Coordinator Jobs in Boca Raton, FL

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Position Summary

This is an individual contributor role.

Designs, develops, contracts, maintains and enhances relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members. Manages and maintains relationships with healthcare providers within a network by negotiating contracts, evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.

• 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.
• Conduct 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 of 5 years' experience in provider relations, network management, healthcare contracting, or payer operations.
• At least 3 years of experience within a Managed Care environment, supporting providers with contracting and contract management.
• Strong working knowledge of healthcare business segments, products, and industry terminology.
• Demonstrated problem-solving and decision-making skills.
• Proven ability to collaborate cross-functionally to support provider network management initiatives.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook).
• Must reside in the state of Florida.

Preferred Qualifications

• Commercial and Medicare knowledge and experience.

Education

• Bachelor's degree preferred or a combination of professional work experienceand 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.