VP Provider Network Management

Superior Dental Care, Inc.; Cleveland (OH); On-site; USD 190,000 - 270,000; Full time

Benefits offered by this job

On-site fitness centers

Gym membership reimbursement

On-site cafeteria

Discounts for employees

Cash rewards program

Employee bonus program

401(k) with company match

Health Savings Account with company**,

Comprehensive health/dental/vision/dis

Job summary

Medical Mutual seeks an executive to lead the provider network strategy, contracting, and reimbursement initiatives. This role drives network development across physician, professional, institutional, and ancillary providers while balancing cost, access, quality and compliance.

The senior leader will negotiate complex contracts, align strategies with enterprise goals, and partner with Sales, Marketing, Product, Finance and Legal to support growth and Customer needs.

Qualifications

• Bachelor’s degree in Business or Health Care Administration or related field.
• Master’s degree preferred.
• 10+ years progressive experience in health care administration, provider contracting and/or managed care.
• 8 years experience in a progressive leadership capacity.

Responsibilities

• Leads development and administration of provider network strategies, including contracting and reimbursement.
• Oversees complex provider contract negotiations and alignment with enterprise objectives.
• Collaborates with cross-functional leaders to support new business opportunities and requests.
• Provides executive leadership to provider network operations and performance.
• Guides policy interpretation and resolution of escalated provider issues.

Skills

Provider contracting

Network development

Reimbursement strategy

Provider relationship management

Leadership

Healthcare administration

Regulatory compliance

Education

Bachelor's degree in Business or Health Care Administration

Master's degree preferred

Job description

Medical Mutual employees must submit their applications through MySource.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Provides executive leadership for the Company’s provider network strategy, including provider contracting, network development, reimbursement strategy, and provider relationship management across physician, professional, institutional, and ancillary providers. Establishes and executes strategies that balance cost, access, quality, regulatory compliance, market competitiveness, and enterprise performance. Leads complex provider negotiations and ensures provider agreements, contracting practices, and reimbursement approaches are in alignment with corporate objectives, customer needs, and applicable government regulations.

Responsibilities:

• Leads the development, implementation, and administration of institutional, professional, and ancillary provider network strategies, including contracting, reimbursement, incentive, access, quality, and affordability strategies. Establishes policies and decision frameworks that optimize network value for customers, support provider performance, improve medical cost management, and advance corporate financial and strategic objectives.
• Provides executive direction and oversight for complex, high-impact provider contract negotiations, including review of proposed contract terms, approval of negotiation strategies, resolution of escalated issues, and alignment of concurrent negotiations with enterprise network, financial, compliance, and market objectives.
• Partners with Sales, Marketing, Product, Finance, Legal, and other enterprise leaders to support new business opportunities, retention efforts, customer inquiries, sales presentations, and RFP responses. Represents provider network strategy in customer-facing forums and ensures network capabilities, access, cost, and quality positioning are clearly aligned with market and customer needs.
• Provides executive leadership to provider network operations and related teams responsible for provider access, affordability, provider satisfaction, provider education, and operational performance. Sets priorities, allocates resources, monitors performance, and develops leadership capability to ensure the organization delivers effective provider network outcomes.
• Provides provider network leadership for new product development and implementation, ensuring network design, provider access, reimbursement strategy, regulatory requirements, and operational capabilities are considered early and aligned with enterprise growth, affordability, and customer objectives.
• Provides executive guidance on provider policy interpretation and resolution of escalated provider issues, including matters involving reimbursement, contract administration, provider relations, and customer impact. Represents the organization in high-level provider discussions and may deliver or sponsor education on reimbursement and network strategies.

Qualifications:

Education and Experience:

• Bachelor’s degree in Business or Health Care Administration or related field. Master's Degree preferred.
• 10+ years progressive experience in health care administration, provider contracting and/or managed care.
• 8 years experience in a progressive leadership capacity.

Technical Skills and Knowledge:

• Comprehensive knowledge of health care operations, the health insurance industry and provider network management processes and best practices.
• Strong knowledge of health plan regulations.
• Knowledge of health care products and Medicare/Medicaid.

Ability to regularly travel to offsite locations.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That\'s why we offer an exceptional package that includes:

A Great Place to Work:

• Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-LS1 #LI-ONSITE

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.