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Manager, Provider Network Operations

Company: AvMed
Location: Miami
Posted on: April 10, 2021

Job Description:

Embrace better opportunities.Are you passionate about health, happiness and helping others? So are we. We're committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate's personal and professional growth. From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!Position: Manager, Provider Network OperationsScope of position: The Provider Network Operations Manager shall be responsible for the management of the Provider Network Operations department and the functions it provides in support of AvMed's Unit Cost Contracting and Value Based Relationship strategies. These functions include but are not limited to: provider servicing; facility and ancillary data management; contract life-cycle management and maintenance; provider roster management; contract process improvement and implementation; analytical reporting; claims reconciliation, and other continuous improvement activities aimed towards enhancing the provider and member experience. The Provider Network Operations department shall be governed as the liaison between the Network Division (Unit Cost Contracting and Value Based Relationships) and the rest of the organization (Credentialing, PDM, Configuration, etc.) The Manager of Provider Network Operations will provide input to strategic decisions that affect the functional area of responsibility.We offer:Competitive SalariesComprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more...Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In401(k)plan with matching contributions, Tuition Assistance, Associate DiscountsYou have:Bachelor's degree required. Masters preferred.6 to 10 years of HMO management experience in the field of provider contracting and network management with an understanding and knowledge of provider data management, hospital & ancillary contracting and/or value-based contracting.Basic knowledge of provider data system configuration and credentialing.Experience with, or knowledge of, claims payment processes preferred.Needs to have managed a team within a health plan for at least 5 years.You May Also Have:Excellent verbal and written communication skillsProficient in Microsoft Word, Outlook, Excel, and PowerPointAble to create comprehensive Excel data spreadsheets, work with Excel formulas, and create reportsProficient in Microsoft Windows environmentBasic claims payment system knowledgeWell organized, with the ability to handle multiple and competing prioritiesIs adept at aligning resources to achieve key objectivesFull understanding of the business, regulatory and competitive environmentsMaintains awareness of industry trends in the market and at the national levelEQUIPMENT SKILLS:KeyboardAdvanced knowledge of personal computers and softwareEnvironment:At AvMed, you'll find a family. Our Associates love all the opportunities for advancement, the flexible work environment and team activities. We also encourage our Associates to embrace a life rich in what matters most - health and happiness. We call it beingWELLfluent. Join AvMed. Join theWELLfluent!Location: AvMed is located near the internationally popular Dadeland Mall, adjacent to a wide variety of residential neighborhoods ranging from pedestrian-friendly urban-style communities to beautiful green suburbs. It is also easy to access through public transportation - a short walk from the Metrorail - and major highways so all that Miami has to offer is within reach.AvMed is a tobacco/drug free workplace, EOE

Keywords: AvMed, Miami , Manager, Provider Network Operations, Executive , Miami, Florida

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