Director, Provider Network Management
Medical Mutual, West Chester, OH, United States
Medical Mutual employees must submit their applications through MySource.
Note: Position requires 4 days on-site per week at our Brooklyn or West Chester, OH office.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary Oversees the Company's relationships with physician, professional, institutional, and ancillary providers including negotiation and implementation of contracts and reimbursement strategies, with the goals of achieving the best-in-market mix of cost, access, and quality. Engages in, supports, and implements corporate strategies, policies, and initiatives to assigned geographic region.
Responsibilities
Reviews proposed contracts and manages multiple concurrent negotiation processes to achieve annual local and regional network targets related to cost, access, methodology, language and quality across all lines of business.
Establishes and maintains strong, collaborative relationships with high volume/complex providers and health systems including institutional, professional and ancillary provider networks across all product offerings. Promotes reduction and/or control of health care costs and efficiencies and improved operational interactions between both organizations.
Directs assigned operations and staff including provider access; improving quality and clinic outcomes; provider satisfaction and education; and staff resources, performance management and learning and development.
Partners with Sales, Clinical, Network Informatics and other areas to achieve Customer satisfaction goals and support provider partnerships.
Collaborates with internal resources and external providers and others to support departmental and company projects and initiatives as well as corporate participation in governmental and/or specialty products as they are developed.
Participates in the preparation of documentation to ensure regulatory compliance and the networks achieves and maintains applicable accreditation standards.
Performs other duties as assigned.
Qualifications Education and Experience
Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field.
In lieu of Degree, may consider equivalent combination of education and experience.
Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.
8 years progressive experience in provider network development, managed care, or equivalent, 5 years of which are in a managerial or leadership capacity.
Experience in establishing and maintaining provider networks for specific products including commercial and government programs.
Technical Skills and Knowledge
Comprehensive knowledge of provider network development, contracting, contracting methodology, contract language, managed care, and regulations and the ability to apply advanced concepts to company operations.
Strong analytical and problem-solving skills.
Strong negotiation skills.
Strong interpersonal skills with the ability to communicate and present to all levels of management.
Ability to effectively utilize computer systems and company web-based support tools.
Proficiency with Microsoft Office.
Benefits and Compensation
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
Investment in You
Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio; we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing.
Equal Opportunity Employer The employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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Note: Position requires 4 days on-site per week at our Brooklyn or West Chester, OH office.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary Oversees the Company's relationships with physician, professional, institutional, and ancillary providers including negotiation and implementation of contracts and reimbursement strategies, with the goals of achieving the best-in-market mix of cost, access, and quality. Engages in, supports, and implements corporate strategies, policies, and initiatives to assigned geographic region.
Responsibilities
Reviews proposed contracts and manages multiple concurrent negotiation processes to achieve annual local and regional network targets related to cost, access, methodology, language and quality across all lines of business.
Establishes and maintains strong, collaborative relationships with high volume/complex providers and health systems including institutional, professional and ancillary provider networks across all product offerings. Promotes reduction and/or control of health care costs and efficiencies and improved operational interactions between both organizations.
Directs assigned operations and staff including provider access; improving quality and clinic outcomes; provider satisfaction and education; and staff resources, performance management and learning and development.
Partners with Sales, Clinical, Network Informatics and other areas to achieve Customer satisfaction goals and support provider partnerships.
Collaborates with internal resources and external providers and others to support departmental and company projects and initiatives as well as corporate participation in governmental and/or specialty products as they are developed.
Participates in the preparation of documentation to ensure regulatory compliance and the networks achieves and maintains applicable accreditation standards.
Performs other duties as assigned.
Qualifications Education and Experience
Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field.
In lieu of Degree, may consider equivalent combination of education and experience.
Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.
8 years progressive experience in provider network development, managed care, or equivalent, 5 years of which are in a managerial or leadership capacity.
Experience in establishing and maintaining provider networks for specific products including commercial and government programs.
Technical Skills and Knowledge
Comprehensive knowledge of provider network development, contracting, contracting methodology, contract language, managed care, and regulations and the ability to apply advanced concepts to company operations.
Strong analytical and problem-solving skills.
Strong negotiation skills.
Strong interpersonal skills with the ability to communicate and present to all levels of management.
Ability to effectively utilize computer systems and company web-based support tools.
Proficiency with Microsoft Office.
Benefits and Compensation
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
Investment in You
Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio; we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing.
Equal Opportunity Employer The employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr