Managed Care Provider Relations Manager jobs in Cincinnati, OH

Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager - Provider Relations (Network Strategy)
  • EyeMed Vision Care
  • Mason, OH FULL_TIME
  • Requisition ID: 837269
    Position:Full-Time
    Total Rewards: Benefits/Incentive Information

    There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same. And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

    Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear. In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands. Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

    If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.
    GENERAL FUNCTION
    The Manager, Network Strategy is responsible for leading projects, analytics, and day to day management to support the provider network and provider economics functions. The Manager will partner with the Provider Contracting team on initiatives to ensure the EyeMed Provider Agreement and associated fee schedules support the objectives of those initiatives. The Manager will provide recommendations to leadership and lead projects related to supporting provider escalations, recruiting & contracting efforts, custom network builds, and overall provider economics.

    MAJOR DUTIES AND RESPONSIBILITIES
    • Lead and develop recommendations for high priority Provider Relations projects and initiatives related to network strategy and provider economics.
    • Ensure recommendations align with organizational goals and other key stakeholders objectives.
    • Partner with Provider Communications, Provider Experience, and Call Center teams to ensure network strategy initiatives are supported with appropriate provider communications and interactions.
    • Identify opportunities for network simplification and work with internal stakeholders to implement recommendations.
    • Partner with Sales and Account Management team to intake, analyze, and provide recommendations on Strategic Provider needs and custom network builds
    • Partner with Configuration & Operations teams to launch new networks to support strategic client needs
    • Establish and maintain regular leadership dashboards on network management, network health, and provider economics
    • Lead efforts and provide recommendations to leadership on provider escalations, including but not limited to reimbursement increases, network adds, and change of ownership.
    • Collaborate with Contracting and Operations teams in planning and design of contract management system enhancements
    • Support departmental collaboration with Legal, Finance, Pricing, Operations, and Compliance to ensure understanding and compliance with provider agreements and associated fee schedules
    BASIC QUALIFICATIONS
    • Bachelor’s Degree in Business or related field, or equivalent work experience
    • 5 years of experience in business strategy, operations, contract management, or other related field
    • Demonstrated success in problem solving, collaboration and communication
    • Able to identify obstacles quickly and develop solutions that support the business
    • Strong organizational and time management skills
    • Strong critical thinking and data analysis skills
    • Strong oral and written communication skills
    • Advanced knowledge of Microsoft Office
    PREFERRED QUALIFICATIONS
    • Experience in the healthcare industry / provider relations
    • Knowledge and understanding of plan benefit designs, standards of administration, etc.,
    • Self-motivated and works independently with minimal supervision
    • Experience leading resolution to cross-functional issue resolution
    • Business Objects reporting experience
    Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

    Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.

    We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.
  • 1 Month Ago

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Manager - Provider Relations (Network Strategy)
  • EssilorLuxottica
  • Mason, OH FULL_TIME
  • Requisition ID: 837269 Position:Full-Time Total Rewards: Benefits/Incentive Information There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the ...
  • 1 Month Ago

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Direct Support Professional (DSP)
  • EBE Care Provider
  • Cincinnati, OH PART_TIME
  • IMMEDIATE PART TIME DIRECT SUPPORT PROFESSIONAL POSITION!! LOCATION :KENWOOD AREA HOURS: FRIDAY 10 P- SUNDAY 3P , OVERNIGHT SLEEP HOURS 12A-8A Roles and Job Descriptions: Direct Support Professional J...
  • 22 Days Ago

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Managed Care Nurse Staff
  • Western & Southern Financial Group
  • CINCINNATI, OH FULL_TIME
  • Overview Summary of Responsibilities: Provides concurrent and retrospective utilization reviews, large case management, disability case management and other programs to improve the quality of medical ...
  • 2 Days Ago

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Managed Care Biller
  • CommuniCare Family of Companies
  • Cincinnati, OH FULL_TIME
  • Managed Care BillerDue to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.PURPOSE/BELIEF STATEMENTThe positi...
  • 6 Days Ago

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Managed Care Biller
  • CommuniCare Family of Companies
  • Cincinnati, OH FULL_TIME
  • Managed Care BillerDue to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.PURPOSE/BELIEF STATEMENTThe positi...
  • 6 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Cincinnati, OH area

Cincinnati (/ˌsɪnsɪˈnæti/ SIN-sih-NAT-ee) is a major city in the U.S. state of Ohio, and is the government seat of Hamilton County. Settled in 1788, the city is located at the northern side of the confluence of the Licking and Ohio rivers, the latter of which marks the state line with Kentucky. The city drives the Cincinnati–Middletown–Wilmington combined statistical area, which had a population of 2,172,191 in the 2010 census making it Ohio's largest metropolitan area. With a population of 296,943, Cincinnati is the third-largest city in Ohio and 65th in the United States. Its metropolitan ar...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$98,678 to $142,345
Cincinnati, Ohio area prices
were up 1.1% from a year ago

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