Jobs
>
Tampa

    Health Partner Network Manager(Needs to live in Florida) - Tampa, United States - CareSource

    CareSource
    CareSource Tampa, United States

    3 weeks ago

    Default job background
    Description
    Job Summary:

    CareSource is a healthcare company that's growing rapidly with a lot of exciting things on the horizon. In Florida, ImagineCare was formed by Spark Pediatrics and CareSource to provide differentiating care and service to Florida SMMC Medicaid members and their providers. CareSource is looking for highly skilled professionals to transform the lives of ImagineCare enrollees through innovative health and life services.

    The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market.

    Essential Functions:
    • Create, execute and administer value based reimbursement (VBR) strategies as directed
    • Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives
    • Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
    • Responsible for following up / auditing providers as they proceed through the loading process to ensure accuracy
    • Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails
    • Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance
    • Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
    • Build networks to support new products within the market and on-board new providers
    • Responsible for complying with all regulatory requirements
    • Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed
    • Participate in training sessions for providers and staff as appropriate
    • Support the contracting requirements of the corporation for geographic regions and products
    • Knowledgeable of federal and state laws and regulations pertaining to provider contracting
    • Assist with development and review of payment policies and provider notifications
    • As requested, become a Subject Matter Expert on specific provider types
    • Mentor junior contractors, as requested
    • Perform any other job duties as requested
    Education and Experience:
    • Bachelor's degree in a healthcare related field, or equivalent years of relevant work experience is required
    • Master's Degree is preferred
    • Minimum of three (3) years of Healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
    • Managed care experience is highly preferred
    Competencies, Knowledge and Skills:
    • Intermediate proficiency level with Microsoft Outlook Word, and Excel
    • Knowledge of Provider Network Management Processes & Services
    • Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
    • Strong negotiation skills
    • Effective oral and written communication skills
    • Critical listening and thinking skills
    • Training/teaching skills
    • Time management skills
    Licensure and Certification:
    • Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated.
    • To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
    • CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
    Working Conditions:
    • General office environment; may be required to sit or stand for extended periods of time
    • Perform reasonable travel, up to 30% to fulfill the duties of the position
    Compensation Range:
    $69, $111,000.00
    CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

    Compensation Type (hourly/salary):
    Salary

    Organization Level Competencies
    • Create an Inclusive Environment
    • Cultivate Partnerships
    • Develop Self and Others
    • Drive Execution
    • Influence Others
    • Pursue Personal Excellence
    • Understand the Business
    This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
  • Qualawash

    IT Network Manager

    3 weeks ago

    Qualawash Tampa, United States

    Quala (DCI) is seeking a highly skilled and experienced Network Manager to manage our networks, ensuring the stability, performance, and security of our network infrastructure. Your expertise in firewalls, SDWAN, Local Area Network management, VLAN management, and network securit ...

  • Kuehne+Nagel

    QuickSTAT-National Air Logistics Network Manager

    1 week ago

    Kuehne+Nagel Hillsborough, United States Full time, Permanent

    JOB DESCRIPTION Are you ready for a new and exciting leadership opportunity with one of the most successful logistics organizations worldwide? Here at QuickSTAT, we are looking for a new National Air Logistics Network Manager to join our Air Logistics team. This position can sit ...

  • By Light Professional IT Services

    Network Systems Manager

    3 weeks ago

    By Light Professional IT Services Tampa, United States

    Overview · By Light has an opening for a Network Systems Manager supporting the Joint Communications Support Element (JCSE), MacDill AFB, FL. This is a mission-essential position that requires 8x5 standard work hour support at the customer location with the ability to provide on- ...

  • Better Health Group

    Provider Network Development Manager

    2 weeks ago

    Better Health Group Tampa, United States

    Job Description · Job DescriptionOur mission is Better Health. Our passion is helping others. · What's Your Why? · • Are you looking for a career opportunity that will help you grow personally and professionally? · • Do you have a passion for helping others achieve Better Health? ...

  • Physician Partners

    Provider Network Development Manager

    1 month ago

    Physician Partners Tampa, United States

    Our mission is Better Health. Our passion is helping others. · What's Your Why? · • Are you looking for a career opportunity that will help you grow personally and professionally? · • Do you have a passion for helping others achieve Better Health? · • Are you ready to join a grow ...

  • Central Florida Behavioral Health

    Recovery Peer Network Manager

    2 weeks ago

    Central Florida Behavioral Health Tampa, United States

    Recovery Peer Network Manager · **Come Put your Experience to Use** · **and Work with Great People** · Central Florida's Behavioral Health Network, Inc. (CFBHN) is one of the leading behavioral health managing entities in the state of Florida, covering 14 counties. Contracted wit ...

  • Zelis

    Network Account Manager

    1 week ago

    Zelis St. Petersburg, United States Full time

    Position Overview · At Zelis, we're seeking a Network Account Manager to spearhead the management of key leased network partner relationships within an assigned portfolio. Your primary focus will be on ensuring client retention, pinpointing growth opportunities, and optimizing re ...

  • General Dynamics Information Technology

    Program Sr Manager

    1 week ago

    General Dynamics Information Technology Tampa, United States

    Program Sr Manager · Seize your opportunity to make a personal impact as a Program Sr Manager supporting the SOF Enterprise. GDIT is your place to make meaningful contributions to challenging projects and grow a rewarding career. · At GDIT, people are our differentiator. As a Pro ...

  • Signode

    Senior Network Engineer

    4 weeks ago

    Signode Tampa, United States

    About Signode: · With over $2B in revenue, 80+ manufacturing facilities across 6 continents and over 9,000 employees worldwide, Signode is a leading manufacturer of a broad spectrum of transit packaging consumables, tools, software, and equipment that optimize end-of-line packagi ...

  • Jacobs

    Information Assurance Security Specialist

    2 weeks ago

    Jacobs Tampa, United States

    Your Impact: · Challenging Today. Reinventing Tomorrow. · We're invested in you and your success. Everything we do is more than just a project. It's our challenge as human beings, too. That's why we bring a thoughtful and collaborative approach to every one of our partnerships. · ...

  • General Dynamics Information Technology

    Network Engineer Sr Advisor

    2 weeks ago

    General Dynamics Information Technology Tampa, United States

    Please take this opportunity to join one of GDIT's fastest long-standing growing programs · US Battlefield Information Collection and Exploitation System eXtended (US BICES-X) is a cutting-edge program supporting DoD intelligence information sharing on current and emerging global ...

  • Jacobs

    Cybersecurity Systems Analyst

    2 weeks ago

    Jacobs Tampa, United States

    Your Impact: · Challenging Today. Reinventing Tomorrow. · We're invested in you and your success. Everything we do is more than just a project. It's our challenge as human beings, too. That's why we bring a thoughtful and collaborative approach to every one of our partnerships. · ...

  • Jacobs

    Information Assurance Security Specialist – Senior

    2 weeks ago

    Jacobs Tampa, United States

    Your Impact: · Challenging Today. Reinventing Tomorrow. · We're invested in you and your success. Everything we do is more than just a project. It's our challenge as human beings, too. That's why we bring a thoughtful and collaborative approach to every one of our partnerships. · ...

  • MASC Medical Recruitment Firm

    Provider Relations Specialist

    4 weeks ago

    MASC Medical Recruitment Firm Tampa, United States

    Position: Senior Provider Contracting Specialist · Role Overview: · This advanced-level position is pivotal in establishing and nurturing strategic, creative, and data-driven partnerships with healthcare providers. The specialist will work autonomously to drive performance improv ...

  • Ashley Furniture Industries

    Senior Network Engineer

    4 days ago

    Ashley Furniture Industries Tampa, United States

    Join The #1 Furniture Company-Join The #1 Furniture Brand · Ashley Furniture Industries, Inc. is the largest manufacturer of furniture in the world. Established in 1945, Ashley offers one of the industry's broadest product assortments to retail partners in 123 countries. · Are yo ...

  • Optum

    Regional Medical Director Care and Value

    1 day ago

    Optum Tampa, United States Full time

    For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. · The Regional Medical Director for Care and V ...

  • Jacobs

    Information Assurance Security Specialist – Junior

    2 weeks ago

    Jacobs Tampa, United States

    Your Impact: · Challenging Today. Reinventing Tomorrow. · We're invested in you and your success. Everything we do is more than just a project. It's our challenge as human beings, too. That's why we bring a thoughtful and collaborative approach to every one of our partnerships. · ...

  • Stellar Innovations

    A GIS Engineer is a professional who specializes in the design, development, and maintenance of Geographic Information Systems

    1 week ago

    Stellar Innovations Palm River-Clair Mel, United States

    Helmholtz-Zentrum Hereon · The Helmholtz-Zentrum Hereon conducts top international research for a changing world: Around 1,000 employees contribute to addressing climate change, sustainable use of global coastal systems, and resource-compatible improvement of quality of life. Fro ...

  • Power3 Solutions and Partnering Companies

    Cyber Security Technical Lead

    2 weeks ago

    Power3 Solutions and Partnering Companies Tampa, United States

    DSSP is looking to hire an energetic, forward-thinking Cyber Security Technical Lead professional for the Special Operation Command Information Technology Enterprise Contract · Location: MacDill AFB, FL · Employment Type: Full-time · Salary: $125k - $200k · The Cyber Security Tec ...

  • General Dynamics Information Technology

    Cyber Security Analyst Senior

    2 weeks ago

    General Dynamics Information Technology Tampa, United States

    Please take this opportunity to join one of GDIT's fastest long-standing growing programs · US Battlefield Information Collection and Exploitation System eXtended (US BICES-X) is a cutting edge program supporting DoD intelligence information sharing on current and emerging global ...