Manager, Provider Service Engagement Job Listing at Medical Mutual in OH (Job ID 2500217)

Description

Note: This is a fully remote opportunity based in Ohio. Requires occasional on-site presence at our Brooklyn, Cincinnati, or Toledo offices as needed.

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.

Collaborates with providers and internal partners to drive on-going service improvements, overall provider relationship strategy, and assess/resolve service impacts; and manages the Provider Service Representative (PSR) group that supports these activities. In addition, develops and enhances business to business relationship through direct contact with key provider partners in assigned region, including hospital systems. Conducts need assessment and develops a strategic action plan on targeted providers, ultimately increasing provider satisfaction and network retention.  Supports service level agreement metrics for identified hospitals, in exchange for rate improvement.  Supports and provides guidance around Availity tools to assist provider administrative burden reduction.

Responsibilities

·         Collaborates and strategizes with providers and internal partners to drive overall provider relationship strategy.

·         Partners with internal stakeholders to assimilate operations into provider's day-to-day operations and resolve complex provider issues and appeals.

·         Participates and helps coordinate operational Joint Operation Committees (JOC) of selected provider partners.

·         Manages Provider Services Representatives including delegation of work, scheduling, performance management, training and development and supporting the removal of barriers for resolution of issues.

·         Develops and sustains relationships with senior leadership of key provider partners in assigned region. Develops and participates in workgroups to help solve provider issues. Analyzes current and historical provider data to enhance provider relationship and assist with root cause analysis.

·         Prepares and analyzes hospital partner-specific data to make recommendations and assume responsibility for relationship management of the provider partner.

·         Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.

·         Reviews provider partner service needs and trends and develops and maintains strategic action plans outlining needs and objectives and how the Company can achieve the objectives. Creates communication summaries to further support the provider partner relationship.

·         Serves as a Subject Matter Expert (SME) in understanding and leveraging industry trends and innovation and informs groups of pertinent policy, product, and legislative changes. Represents “provider” in applicable corporate projects, attending meetings and participating in workgroups.

·         Performs other duties as assigned.

Qualifications

Education and Experience

·         Bachelor's degree in business or healthcare administration, marketing, or related field.

·         8 years of strategic account service experience in financial services or healthcare, which includes provider network management and cross functional project management.

·         3 years of experience in leadership or in a high-level individual contributor role.

Professional Certification(s):

·         Certified Project Management Professional (PMP) and/or Six Sigma training, preferred not mandatory.

Technical Skills and Knowledge

·         Excellent oral, written interpersonal, analytical, and negotiation skills.

·         Ability to understand the dynamics of the payer/provider partnership.

·         Business acumen and the ability to develop short- and long-term strategies.

·         Comprehensive knowledge of provider network management/relations processes and best practices.

·         Knowledge of assigned local healthcare market.

·         Intermediate to advanced Microsoft Office and database reporting skills.

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:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, 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.
• Business casual attire, including jeans.

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.