Provider Network & Relations Lead for Medicare Advantage

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

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.