Network and Provider Relations Manager

CommuniCare Advantage; Annandale (VA); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

PTO

Life and disability coverage

Medical, dental and vision coverage

401(k) with employer match

Flexible Spending Accounts

Job summary

CommuniCare Advantage in Virginia seeks a Network and Provider Relations Manager to execute a strategic plan to recruit, service and support network providers across the region. The role focuses on contract negotiations, relationship development and ensuring provider satisfaction through on-site visits and timely issue resolution.

The ideal candidate has a bachelor’s degree with 5+ years in network management or provider relations, knowledge of Medicare programs, proficiency with MS Office, a

Qualifications

• Bachelor's degree and 5+ years in network management/provider relations.
• Working knowledge of Medicare programs.
• Proficiency with MS Office Suite.
• Valid driver's license and willingness to travel 50% of the time.

Responsibilities

• Develop the provider network through contract negotiations, relationship development and servicing all provider types.
• Maintain positive provider relationships with provider community via on-site visits and timely issue resolution.
• Serve as knowledge/resource expert regarding provider issues and educate on contracts and non-routine claims.

Skills

Communication skills

Deadline-oriented

Cultural competency

Education

Bachelor's degree

Tools

MS Office Suite

Driver's license

Job description

Job Address:10123 Alliance Road, Suite 320 Blue Ash, OH 45242Network and Provider Relations ManagerCommuniCare Advantage, a member of CommuniCare Health Services, is currently recruiting a Network and Provider Relations Manager to support our Medicare Advantage plan in the state of Virginia.PURPOSE/BELIEF STATEMENTThe 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.BENEFITSAs a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.QUALIFICATIONS AND EXPERIENCE REQUIREMENTSBachelor'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 SuiteMust possess valid driver's license.Must be willing to travel within the service area at least 50% of the timeKNOWLEDGE/SKILLS/ABILITIESMust 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.JOB DUTIES AND RESPONSIBILITIESDevelop 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.About UsSince 1984, CommuniCare Family of Companies has delivered exceptional, person‑centered post‑acute care. A national leader operating more than 105 skilled nursing and long‑term care facilities, CommuniCare serves nearly 13,000 residents with integrated services spanning the full continuum of care. Guided by our mission, Serve with Pride, we support communities across Ohio, Indiana, Virginia, and West Virginia.