Employment Type:

Shift:

Description:

Why MediGold?

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

Position Purpose:

The Market Manager - Provider Relations and Network Development is responsible for the strategic oversight of a geographic area or market of Provider Relations Managers. The Market Manager Provider Relations and Network Development will maintain a portfolio of provider relations work within the area or market (including contracting, recruitment, provider retention and strategy development) along with ensuring area or market level targets are aligned with organizational objectives. The Market Manager-Provider Relations and Network Development may also manage a team/function within the broader Network Management arena.

What we are looking for:

• Education: Bachelor’s Degree in business administration, finance, health administration or similar field preferred
• Experience: 5 or more years of relevant work experience in health plan provider relations including experience in leadership roles
• Ability to supervise, lead and motivate colleagues in a team-building collaborative atmosphere.
• Demonstrated ability to influence and create solutions when complex issues arise
• Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality
• · Working knowledge of protocols and procedures of Centers for Medicare and Medicaid Services
• Proven ability to work effectively with internal and external multi-disciplinary teams and key internal/external stakeholders across
• Valid driver's license
• Requires use of a personal vehicle with valid auto insurance

What you will do:

• Responsible for supporting Clinically Integrated Networks (CIN) and networks across broad regions with focus on system wide contracting opportunities.
• Develop and implement a network development plan for multiple regions.
• Work with senior leadership to design, develop and implement value based programs (APM) that meet and reward quality and meet the goals of triple AIM.
• Manage and support staff across an area/market to ensure departmental and company wide goals are met.
• Responsible for supporting the CIN governance structure to ensure actions for the board are executed upon a timely and reportable fashion.
• Leads expansion opportunities into new states to ensure CMS adequacy and product salability by leveraging Quest Analytics and Zelis (or related tool) to benchmark against competitors.
• Supports applicable CIN committee by providing network adequacy, capacity, and participation information and developing strategies related to filling gaps and growing the network.
• Manages staff relations including performance management, staff satisfaction, and conflict management. Performs and oversees scheduling, recruitment, payroll, and student engagements
• Monitors departmental budgets, regulatory compliance, departmental contracts, and vendor relations
• Provides leadership and direction regarding MediGold enrollment, membership and credentialing policies.

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our four hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

--

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.