Network and Provider Relations Manager

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Network and Provider Relations Manager

CommuniCare Advantage, a member of CommuniCare Health Services, is currently recruiting a Network and Provider Relations Manager to support our Medicare Advantage plan in the state of Virginia.

PURPOSE/BELIEF STATEMENT

The Network and Provider Relations Manager is responsible for the execution of a strategic plan to recruit, service and support network providers in an assigned geographic area.

BENEFITS

As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. 

QUALIFICATIONS AND EXPERIENCE REQUIREMENTS

• Bachelor's degree and a minimum 5 years of experience working in network management and/or provider relations.
• Must have a working knowledge of Medicare programs.
• Must possess solid knowledge and understanding of managed care industry; and local market conditions.
• Proficiency in MS Office Suite
• Must possess valid driver's license.
• Must be willing to travel within the service area at least 50% of the time

KNOWLEDGE/SKILLS/ABILITIES

• Must have integrity and a strong ethical compass.
• Must be flexible, able to work independently, and able to achieve deadlines and deliverables with minimal supervision.
• Must have strong communication skills and ability to work effectively with people coming from diverse cultural and professional perspectives.

JOB DUTIES AND 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.

About Us

Since 1984, CommuniCare Family of Companies has delivered exceptional, person‑centered post‑acute care. A national leader operating more than 105 skilled nursing and long‑term care facilities, CommuniCare serves nearly 13,000 residents with integrated services spanning the full continuum of care. Guided by our mission, Serve with Pride, we support communities across Ohio, Indiana, Virginia, and West Virginia.