VP Provider Network Management

Medical Mutual•Cleveland, OH

18h•Onsite

About The Position

Provides executive leadership for the Company’s provider network strategy, including provider contracting, network development, reimbursement strategy, and provider relationship management across physician, professional, institutional, and ancillary providers. Establishes and executes strategies that balance cost, access, quality, regulatory compliance, market competitiveness, and enterprise performance. Leads complex provider negotiations and ensures provider agreements, contracting practices, and reimbursement approaches are in alignment with corporate objectives, customer needs, and applicable government regulations.

Requirements

Bachelor’s degree in Business or Health Care Administration or related field.
10+ years progressive experience in health care administration, provider contracting and/or managed care.
8 years experience in a progressive leadership capacity.
Comprehensive knowledge of health care operations, the health insurance industry and provider network management processes and best practices.
Strong knowledge of health plan regulations.
Knowledge of health care products and Medicare/Medicaid.
Ability to regularly travel to offsite locations.

Nice To Haves

Master's Degree preferred.

Responsibilities

Leads the development, implementation, and administration of institutional, professional, and ancillary provider network strategies, including contracting, reimbursement, incentive, access, quality, and affordability strategies.
Establishes policies and decision frameworks that optimize network value for customers, support provider performance, improve medical cost management, and advance corporate financial and strategic objectives.
Provides executive direction and oversight for complex, high-impact provider contract negotiations, including review of proposed contract terms, approval of negotiation strategies, resolution of escalated issues, and alignment of concurrent negotiations with enterprise network, financial, compliance, and market objectives.
Partners with Sales, Marketing, Product, Finance, Legal, and other enterprise leaders to support new business opportunities, retention efforts, customer inquiries, sales presentations, and RFP responses.
Represents provider network strategy in customer-facing forums and ensures network capabilities, access, cost, and quality positioning are clearly aligned with market and customer needs.
Provides executive leadership to provider network operations and related teams responsible for provider access, affordability, provider satisfaction, provider education, and operational performance.
Sets priorities, allocates resources, monitors performance, and develops leadership capability to ensure the organization delivers effective provider network outcomes.
Provides provider network leadership for new product development and implementation, ensuring network design, provider access, reimbursement strategy, regulatory requirements, and operational capabilities are considered early and aligned with enterprise growth, affordability, and customer objectives.
Provides executive guidance on provider policy interpretation and resolution of escalated provider issues, including matters involving reimbursement, contract administration, provider relations, and customer impact.
Represents the organization in high-level provider discussions and may deliver or sponsor education on reimbursement and network strategies.

Benefits

On-site fitness centers
Gym membership reimbursement
On-site cafeteria
Discounts at many places
Opportunity to earn cash rewards for shopping with our 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
Excellent medical, dental, vision, life and disability insurance
Access to an 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