Director, Provider Service Engagement Job Listing at Medical Mutual in OH (Job ID 2500185)

Description

Note: this is a fully remote opportunity based in Ohio.

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.

Leads the improvement of provider operational relationships, as well as identifies operational efficiency within the provider community. Provides strategic leadership for Provider Network Management and provides representation on internal projects and initiatives across the company. Develops service standards aimed at maintaining positive working relationships with key provider partners. Identifies key providers for service enhancements. Collaborates with internal partners to recommend and implement operational improvements. Supports Provider Experience Managers in creating provider-specific strategies. Monitors and develops internal processes and dashboards to support goals of Provider Network Management department. Reduces overhead expenses of provider processes and network administration and coordinates incentive arrangements to account for that value. Utilizes data from Ohio Hospital Association's scorecard to identify opportunities. Aligns provider engagement with medical management and VBC strategies. Participates in operational Joint Operation Committees (JOC) for larger groups.

Responsibilities

·         Identifies relationship improvement opportunities with our provider community and develop provider specific strategies to aimed at operational and administrative performance improvement.

·         Supports Provider Network Management department by assuring positive operational performance to create a path for reimbursement stability.

·         Represents and/or leads Network Management on various internal and/or external projects and initiatives.

·         Establishes and maintains strong, collaborative relationships with high volume/complex providers and health systems. Promotes efficiencies and improved operational interactions between both organizations.

·         Markets the impact of the above to providers to improve discount rates and lower the total cost of care.

·         Engages with sales teams to support the internal management of unique products and tiering systematic processes.

·         Oversees provider relations activities that educate, engage and support our provider community.

·         Collaborates with internal VP to define provider operational strategy and gain departmental support.

·         Develops provider-centered initiatives in order to increase quality and reduce costs for multiple lines of businesses. Partners with Sales and other areas to achieve Customer satisfaction.

·         Supports the creation of presentations that provide status updates, strategic planning, and achieved results.

·         Identifies cross-departmental processes and cross-provider/MMO processes that impact provider perception of MMO. Identifies and implements short-term and long-term (e.g., Out of Network Claims) process improvements.

·         Develops innovative methods to improve provider and patient/member experiences. Partners with operational and technology teams to coordinate improvement projects and data products to ensure the attainment of needed results.

·         Oversees CCF Contract operating metrics and works with Provider Network Management contractors to determine opportunities to scale the process up to apply to other providers.

·         Ensures attainment of metrics around gold card, initial denials, final denials, and AR.

·         Engages with other high volume facilities operational improvements that support rate parity goals.

·         Develops relationship with Ohio Hospital Association and other industry influencers to understand potential opportunities and strengths.

·         Develops exploratory analytics capability around provider measurements by partnering with data groups in and outside MMO.

·         Develops a team of highly motivated professionals aimed at provider relationship enhancement.

·         Performs other duties as assigned.

Qualifications

Education and Experience

·         Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field.

·         In lieu of Degree, may consider equivalent combination of education and experience.

·         Master's degree in Business Administration (MBA) or Health Care Administration (MHA) preferred.

·         8 years progressive experience in provider network development, managed care, or equivalent, 5 years of which are in a managerial capacity.

·         Experience in establishing and maintaining provider networks for specific products including government programs.

Technical Skills and Knowledge

·         Comprehensive knowledge of provider network development, contracting, managed care, and regulations and the ability to apply advanced concepts to company operations.

·         Strong analytical and problem-solving skills.

·         Strong negotiation skills.

·         Strong interpersonal skills with the ability to communicate and present to all levels of management.

·         Ability to effectively utilize computer systems and company web-based support tools.

·         Proficiency with Microsoft Office.

·         Ability to manage complicated projects involving multiple internal and external stakeholders.

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.