Network and Provider Relations Manager

CommuniCare Health Services•OH CHS SNP, Inc., OH

4d•Hybrid

About The Position

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. This role supports CommuniCare Advantage, a member of CommuniCare Health Services, for their Medicare Advantage plan in the state of Virginia.

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
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.

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.