Director, Provider Management - Florida

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

In this role, you will lead and oversee all aspects of provider network management within Florida, ensuring a comprehensive, high-quality, and compliant provider network. You will be responsible for managing a team of provider relations and engagement professionals, driving network development and optimization efforts to meet regulatory requirements and organizational objectives. This includes working closely with healthcare providers to negotiate contracts, resolve disputes, and maintain positive relationships, while ensuring network adequacy and performance meet Medicaid, Medicare, and commercial standards. You will also collaborate with internal teams such as compliance, legal, operations, and analytics to ensure that the network operates efficiently and adheres to all regulatory requirements. Your work will have a direct impact on access to care, provider satisfaction, and the overall quality of services delivered to members.

The Director of Provider Management will lead a team of provider relations and engagement professionals responsible for maintaining and expanding a comprehensive and compliant network of healthcare providers. This role ensures that the network meets regulatory requirements and provides high-quality, accessible services to members. The Director will develop strategies to strengthen provider relationships, ensure network adequacy, and drive improvements in network performance.

Functional Competencies:

• Lead and manage the Provider Relations team to ensure effective provider engagement, network maintenance, and compliance with state and federal regulations.
• Oversee provider contracting, credentialing, and network development to ensure a robust, compliant, and geographically accessible network.
• Collaborate with internal teams (compliance, operations, and legal) to monitor network adequacy and address gaps or concerns.
• Serve as the primary point of escalation for provider issues, working closely with the team to resolve concerns related to contracts, service delivery, and claims processing.
• Drive continuous improvement in provider performance, engagement, and satisfaction through regular communications, education, and training.
• Develop and implement strategies to enhance provider satisfaction and retention while ensuring alignment with company goals and compliance standards.
• Work with analytics teams to regularly evaluate network performance, identifying areas for improvement and working with providers to meet key performance indicators (KPIs).
• Ensure the provider network is fully compliant with all contractual and regulatory requirements, including state-specific Medicaid standards and Medicare Advantage guidelines.
• Oversee provider onboarding processes, ensuring that new providers are integrated into the network smoothly and efficiently.
• Act as a strategic partner in new business development, offering insights into provider network opportunities and risks.
• Maintain an in-depth understanding of Florida Medicaid and Medicare programs, regulations, and policy changes to anticipate and address provider network needs.

Core Competencies:

• Leadership: Proven ability to lead, mentor, and inspire a team, fostering a collaborative and high-performing work environment.
• Strategic Thinking: Ability to develop and execute strategic plans to enhance provider networks and align with organizational goals.
• Compliance and Regulatory Knowledge: Deep understanding of Medicaid, Medicare, and other relevant healthcare regulations, with the ability to ensure compliance in network operations.
• Communication: Strong interpersonal and communication skills for engaging with providers, internal teams, and external stakeholders at all levels.
• Problem Solving: Aptitude for analyzing complex issues, identifying root causes, and implementing effective solutions.
• Negotiation: Skilled in contract negotiation, with the ability to build mutually beneficial relationships with providers and resolve conflicts efficiently.

Behavioral Competencies:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. 
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
• Flexible and responsive: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
• Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications:

• Bachelor’s degree in healthcare administration, business, or related field.
• 8+ years of experience in provider network management, healthcare contracting, or provider relations, with at least 3 years in a leadership role.
• Strong understanding of Medicaid, Medicare, and commercial insurance network requirements, particularly in Florida.
• Proven ability to manage provider relationships, including contract negotiation, performance evaluation, and conflict resolution.
• Excellent leadership, communication, and organizational skills.
• Familiarity with compliance standards and regulations in the healthcare industry.
• Ability to travel within Florida as needed.
• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.

Preferred Qualifications:

• Experience working with Medicaid/Medicare health plans in Florida.
• Strong analytical and problem-solving skills, with experience in network adequacy and performance metrics.
• Ability to manage multiple priorities and work under tight deadlines

FLSA Status:  Salary/Exempt
National Salary Range:  $110,000 - $155,200

How to stay safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam).  If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!