Provider Network Growth & 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

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.