Job Address:
10123 Alliance Road, Suite 320
Blue Ash, OH 45242
Network and Provider Relations Manager
CommuniCare Advantage, a member ofCommuniCare Health Services, is currently recruiting aNetwork and Provider Relations Managerto support ourMedicare Advantageplan in the state of Virginia.
PURPOSE/BELIEF STATEMENT
The Network and Provider Relations Manager is responsible for the execution of a strategic plan to recruit, service and support network providers in an assigned geographic area.
BENEFITS
As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.
QUALIFICATIONS AND EXPERIENCE REQUIREMENTS
- Bachelor's degree and a minimum 5 years of experience working in network management and/or provider relations.
- Must have a working knowledge of Medicare programs.
- Must possess solid knowledge and understanding of managed care industry; and local market conditions.
- Proficiency in MS Office Suite
- Must possess valid driver's license.
- Must be willing to travel within the service area at least 50% of the time
KNOWLEDGE/SKILLS/ABILITIES
- Must have integrity and a strong ethical compass.
- Must be flexible, able to work independently, and able to achieve deadlines and deliverables with minimal supervision.
- Must have strong communication skills and ability to work effectively with people coming from diverse cultural and professional perspectives.
JOB DUTIES AND RESPONSIBILITIES
- Develop the provider network through contract negotiations, relationship development, and servicing all provider types.
- Develop and maintain positive provider relationships with provider community by regular on-site visits (may be virtual or in person as needed), communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
- Serve as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, research and resolve the most complex provider issues for prompt resolution.
- Provide assistance regarding education, contract questions and non-routine claim issues.
