This is a Provider Network Specialist position with a company in Tampa, FL.

Summary:  Lead the development and managing of iCare's provider contracts where the provider group is sub-capitated (sub-cap). The role reports to the head of Provider Relations. The person will review incoming membership files for the health plans, and then be the framework defined assign those members, on a monthly or weekly basis, to the underlying provider group. This has direct financial costs for iCare and revenue for the practices. This role is expected to work fairly autonomously, with a strong relationship internally with finance. Also responsible for relationship management with assigned provider group(s) and staff, as well as educating with provider group on initiatives that benefit the customer, provider, and health plan.

Duties & Responsibilities: Manage sub-cap network arrangements for sub-cap business for Optometry and Ophthalmology for both internal and external contracts in all geographies. Execute against assignments on a monthly basis ensuring updated sub-cap network enrollment based on network capacity. Participate in the reconciliation of sub-cap enrollment versus sub-cap payment revenue cycle management process as the sub-cap subject matter expert. Responsible for the general oversight of capitated provider network, to include provider data accuracy, trend analysis, and provider engagement. Develops and maintains relationships with providers, practice managers, and care coordination teams with health system/large clinic partners within the capitated network to drive optimal performance on STARS, coding, utilization, and overall financial performance. Collaborate with leadership on review of monthly utilization and patient access with capitated network. Work directly with Health plan to manage Change of Assignment process. Responsible for processing escalated inquiries from Health plan. Participate with Department Leadership in monthly financials.

Requirements and Qualifications[]{#Hlk142289191}[]{#Hlk142304825}: Bachelor's degree in a related field or equivalent experience. Minimum two years experience in provider relations or managed care. Experience with capitated providers and utilization management in a capped setting.

Equal Opportunity/Affirmative Action Employer.