Director, Provider Network Management

Medical Mutual; Olde West Chester (OH); Hybrid; USD 150,000 - 190,000; Full time

Benefits offered by this job

On-site cafeteria

Gym membership reimbursement

Employee bonus program

401(k) with company match

Job summary

Medical Mutual in Ohio seeks a Director, Provider Network Management to oversee relationships with physician, professional, institutional, and ancillary providers, including contract negotiation and reimbursement strategies.

You will lead regional network initiatives, collaborate with Sales, Clinical, and Network Informatics, and ensure regulatory compliance and accreditation.

The role offers a comprehensive benefits package and growth opportunities within a long-standing mutual company.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field.
• 8 years progressive provider network development experience, including 5 in a managerial role.
• MBA or MHA preferred.

Responsibilities

• Reviews proposed contracts and manages multiple concurrent negotiation processes to achieve local and regional targets.
• Establishes and maintains relationships with high-volume providers and health systems.
• Directs operations including provider access, quality outcomes, and staff development.
• Partners with Sales, Clinical, Network Informatics to achieve customer satisfaction goals.
• Collaborates on corporate projects and regulatory compliance for accreditation standards.
• Performs other duties as assigned.

Skills

Negotiation skills

Analytical thinking

Interpersonal skills

Microsoft Office

Provider network development

Contracting knowledge

Communication skills

Education

Bachelor's degree in Business Administration/Healthcare Administration/Finance

MBA or MHA preferred

Job description

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary

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.

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.

Qualifications

Education and Experience

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider equivalent combination of education and experience.
• Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.
• 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.

Technical Skills and Knowledge

• 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.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• 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 - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio; we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.