Provider Operations Manager Jobs in Hialeah, FL (NOW HIRING)

Position Summary:

The Provider Operations Intern will support the Provider Operations team in fostering strong provider relationships through engagement, education, and operational support. This internship provides an opportunity to gain hands-on experience in provider network management, healthcare operations, and compliance. The intern will work up to 29 hours per week and assist with provider outreach, reporting, and process improvement initiatives.

Essential Duties and Responsibilities:

• • Assist in provider outreach and engagement efforts to ensure understanding of policies, procedures, and compliance requirements.
  • Support the Provider Operations team in resolving provider inquiries and operational challenges.
  • Help track provider compliance with company initiatives, including data submission, membership growth, and quality metrics.
  • Assist in preparing provider education materials and workflows to drive operational improvements.
  • Collect and analyze provider performance metrics, assisting in the development of action plans for improvement.
  • Help coordinate Office Manager Meetings and provider training sessions to ensure high engagement.
  • Conduct research on provider network trends, recruitment strategies, and operational efficiencies.
  • Support collaboration efforts with network hospitals and physician groups to strengthen provider relationships.
  • Assist in reviewing provider data accuracy and documenting provider interactions for compliance.
  • Help analyze provider claims and submissions, working with the team to identify trends and ensure accuracy.
  • Participate in process improvement initiatives and make recommendations based on research and analysis.
  • Maintain familiarity with Medicaid and HMO Plan Network Requirements.
  • Document interactions and outreach activities for compliance and reporting purposes.
  • Assist with additional tasks as needed to support provider operations and network management.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• • Must be a current Community Care Plan (CCP) Medicaid member.
  • Interest in healthcare administration, provider relations, or managed care operations.
  • Strong written and verbal communication skills.
  • Ability to work independently and as part of a team.
  • Proficiency in Microsoft Office (Word, Excel, PowerPoint) and data management tools.
  • Strong analytical and problem-solving skills.
  • Detail-oriented with the ability to multitask and manage deadlines.

Skills and Abilities:

• • Strong organizational and time-management skills.
  • Ability to communicate effectively with healthcare professionals.
  • Willingness to learn and adapt in a dynamic healthcare environment.
  • Basic understanding of healthcare operations and provider network management.
  • Ability to analyze and interpret data for decision-making.

WORK SCHEDULE & TRAVEL:

• • Up to 29 hours per week.
  • Mostly remote, with occasional site visits and some in-office days as needed.
  • Some travel required for provider outreach and events.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Background Screening Notice:

In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at: https://info.flclearinghouse.com