Medicare Network Manager

MTM Transit•Wyoming, MI

11d•Remote

About The Position

The Medicare Network Manager will primarily be responsible for the development and maintenance of specialized networks to meet the needs of Medicare Advantage populations. The Medicare Network Manager will own the delivery of a high level of service to our vendors every day, ensuring high operational standards and vendor satisfaction within an assigned geographic area. The Medicare Network Manager would manage the day-to-day interaction with the vendors, acting as an Account Manager to build and sustain strong working relationships with cross functional departments and assigned Providers. This role is key to the success of a successful relationship with our Transportation Providers. Location: Work From Home

Requirements

High School diploma or GED
College Degree or Equivalent Work Experience
2-5 years’ experience as an Account Manager
2 years’ operational experience
Must possess a valid driver’s license
Must be able to conduct inspections, audits, communicate issues, and corrective actions from an authoritative position but with professional courtesy
Demonstrate excellent time management skills
Knowledge of transportation logistics, patient experience, and managed care
Ability to maintain positive and team focused during high stress situations
Persuasive negotiator
Strong ability to pay attention to detail
Excellent communication skills
Ability to maintain high level of confidentiality
Must be able to communicate with staff of all job levels professionally
Ability to prioritize assigned projects, incidents, and requests
Ability to identify with customers' needs and circumstances
Ability to recognize, handle and refer situations of an emergent nature

Nice To Haves

Experience in Project Management and/or Contract Negotiations is preferred
Experience in Cost Management is preferred

Responsibilities

Work with the Transportation Provider (TP) to follow through on service issues, troubleshooting problems and concerns, complaints, and education
Utilize data to develop and deliver performance improvement plans (PIP)
Coordinate and conduct monthly provider performance evaluations
Conduct off boarding for providers not meeting standard expectations
Serve as the first point of contact for all vendor service requests and escalations
Own the day-to-day vendor interaction and satisfaction
Conduct on site vehicle inspections and provider audits to verify compliance with MTM and HIPAA guidelines
Deliver timely, accurate and professional operational support to all vendors within a specified geographic area and Service Level Agreements
Demonstrate proactive leadership by working with internal MTM teams and external client teams, when necessary, to ensure complete resolution of TP issues
Demonstrate proficiency by providing effective consultation to TP’s and guidance to internal team members
Utilize Salesforce as the single source of truth for managing vendor interactions and credentialing compliance
Recognize opportunities to educate TP’s contacts on MTM processes when necessary
Build and sustain a strong working partnership with assigned transportation providers
Assist with/participate/facilitate regular provider town hall meetings
Handle inbound service requests and ensure that they are properly assigned or addressed
Liaise with other internal departments as required to resolve vendor’s issues and questions
Provide ongoing support to transportation providers regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance
Meet or exceed assigned KPI’s and business objectives
Meet all provider compliance requirements, including but not limited to inspections, audits and credentialing, ensuring non-compliant Vendors are not performing services for MTM
Submit provider configuration changes to data management team and partner with them to ensure vendor is set up properly in the systems