Network and Provider Relations Manager

CommuniCare Health; Blue Ash, Northern (OH, KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

PTO

Medical insurance

Dental insurance

Vision insurance

401(k) with employer match

FSA

Job summary

CommuniCare Advantage, a member of CommuniCare Health Services, is seeking a Network and Provider Relations Manager to support its Medicare Advantage plan in Virginia. The role focuses on building and maintaining a robust provider network through contract negotiations, outreach, and service improvements.

You will conduct regular on-site visits (or virtual), educate providers on program changes, resolve issues promptly, and serve as a knowledge expert for complex provider questions.

Qualifications

• Bachelor's degree and 5+ years in network management/provider relations.

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.

Skills

Medicare programs understanding

MS Office Suite

Provider relations

Communication skills

Travel flexibility

Integrity and ethics

Education

Bachelor's degree

Tools

MS Office Suite

Job description

**Network and Provider Relations Manager****CommuniCare 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 STATEMENT**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.**BENEFITS**As 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 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**KNOWLEDGE/SKILLS/ABILITIES*** 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.**JOB DUTIES AND 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.