Director, Provider Network Management

Medical Mutual•West Chester, OH

4d•Hybrid

About The Position

The Director, Provider Network Management 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.

Requirements

Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field.
In lieu of Degree, may consider equivalent combination of education and experience.
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.
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.

Nice To Haves

Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.

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.

Benefits

Laptop, monitors, keyboard, mouse and headset provided.
Access to on-site fitness centers or gym membership reimbursement.
On-site cafeteria.
Discounts at many places in and around town.
Opportunity to earn cash rewards for shopping with customers.
Business casual attire, including jeans.
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Medical, dental, vision, life and disability insurance.
Employee Assistance Program.
Company holidays.
Up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
Parental leave for eligible employees who become parents through maternity, paternity or adoption.
Career development programs and classes.
Mentoring and coaching.
Tuition reimbursement up to $5,250 per year.
Diverse, inclusive and welcoming culture with Business Resource Groups.