This position serves the West Central Florida (Sarasota Manatee counties) you must be based in that area. 50% local travel to visit current and potential network providers will be required. Out of state candidates will not be considered.

Ultimate Health Plans, Inc. (“UHP”) is a fast growing Medicare Advantage health plan with its headquarters located in Spring Hill, Florida. UHP plans provide all the benefits of Original Medicare Parts A and B, plus additional benefits not available with Original Medicare.

We are looking for someone who has worked for a health plan, negotiated contracts, and managed provider relationships. You need to understand Medicare Advantage guidelines and protocols.

Provider Network Manager acts as liaison between providers and the Health Plan to enhance the business relationship. Representative will perform new provider orientations, conduct regular provider visits to address service issues, as well as perform educational outreach with a focus on improving the provider’s quality metrics.

Primary duties may include but are not limited to:

• Enhance provider relationships by researching and resolving provider matters and effectively handling and responding to account changes and correspondence.
• Participates in audits of provider directory data to ensure accuracy of the information.
• Assists with Health Plan’s contracting/credentialing efforts.
• Conduct site visits when required as a part of Provider Credentialing activities
• Conduct initial orientations for professional providers.
• Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, etc.
• Conducts regular provider meetings and distributes educational materials for quality (e.g. HEDIS, CAHPS, HOS, etc.)
• Other duties as assigned.

Education/Experience requirements:

Requires a High School Diploma/GED and 3 years of customer service experience; preferably in a health care or insurance environment. Requires strong oral, written and interpersonal communication skills, problem-solving and presenting skills. Any combination of education and experience, which would provide an equivalent background.

Other requirements:

Must have current driver’s license and insurance; willing to travel to offices in assigned territory 80% or more.

Job Type: Full-time

Pay: $65,000.00 - $71,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Provider Relations and Contracting: 2 years (Required)
• Health Plan: 2 years (Required)
• Contract negotiation: 2 years (Preferred)
• working with PCPs: 1 year (Required)
• HEDIS Measures: 1 year (Preferred)

Willingness to travel:

• 50% (Preferred)

Work Location: On the road