Network and Provider Relations Manager

CHQ CHSI EMP LLC; United States; On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

PTO

Medical, dental, and vision coverage

401(k) with employer match

Flexible Spending Accounts

Job summary

CommuniCare Advantage, part of CommuniCare Health Services, seeks a Network and Provider Relations Manager to support a Medicare Advantage plan in Virginia. Responsibilities include developing and maintaining a provider network, negotiating contracts, and resolving complex provider issues while ensuring service excellence.

The role requires 5+ years in network/provider relations, Medicare knowledge, strong communication, and willingness to travel 50% of the time; a Bachelor's degree is required.

Qualifications

• Bachelor's degree required.
• Minimum 5 years in network management and/or provider relations.
• Working knowledge of Medicare programs.
• Solid understanding of managed care industry and local market conditions.
• Proficiency in MS Office Suite.
• Valid driver's license required.
• Willingness to travel within the service area at least 50% of the time.

Responsibilities

• Develop the provider network through contract negotiations and relationship development.
• Maintain positive provider relationships with regular on-site visits, communicating changes, and facilitating education.
• Serve as a knowledge resource on provider issues and resolve complex problems for prompt resolution.
• Assist with education, contract questions and non-routine claim issues.

Skills

Strong communication skills

Independent work

Travel readiness

Education

Bachelor's degree

Tools

MS Office Suite

Job description

Job Address: 10123 Alliance Road, Suite 320 Blue Ash, OH 45242

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.

About Us

Since 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. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long‑term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.