Department:OH1CH_84730_000 MCHP Provider Contracting
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
MediGold is a not-for-profit Medical Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. 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.
Job Description Details:
The Director, Provider Relations and Contracting position is responsible for innovating and executing the strategic initiatives of MediGold's Provider network, developing new network opportunities as well as enhancing existing network relationships, designing contracting strategies that drive MediGold's desired outcome of the Provider network design, and to serve as the escalation point for risks/issues raised by the Provider network.
- Develops the provider network through contract negotiation, relationship development and serving on behalf of MediGold, including multiple provider types such as physicians, ancillaries and hospitals.
- Establishes and maintains relationships with provider network to ensure quality, satisfaction and contract terms are provided, in collaboration with Provider Relations & Network Managers.
- Serves as lead contractor in negotiations and serves as subject matter expert (SME) for service area contracting efforts.
- Determines the feasibility of reimbursement methodologies and fee schedules while stewarding company financial resources.
- Serves as lead for initiatives around provider contracting, network management, value-based agreements with projects with significant impact.
- Collaborates with Senior Director, Medical Delivery Services and senior leadership to shape organizational provider strategy; May assist leadership in network development planning.
- Provides oversight of quality, performance and financial targets in alignment with MediGold requirements and regulatory agencies.
- Maintains budgetary accountability and authority of departmental budget.
- Prepares financial projections and conducts analysis.
- Maintains excellent working relationships with internal and external partners and Mount Carmel Health System related entities.
- Travels as required
- All other duties as assigned.
- Education: Bachelor's degree in Healthcare Administration, Finance or related field.
- Experience: Minimum five (5) years of experience with a Health Plan or Health Provider including experience in provider contracting and network development experience required.
- Previous management experience required
- Demonstrated ability to collaborate and communicate with internal and external partners with all levels of authority within an organization, including C-Suite colleagues
- Experience in contributing to and executing organizational strategic initiatives
- Proven ability to develop provider networks including augmenting established territories and expanding into new markets
- Ability to leverage health care data analytics to identify trends, create impact analysis assessments, and to shape managerial decisions
- Ability to prioritize and manage high volume tasks and responsibilities simultaneously.
- Ability to build highly productive and cohesive teams
- Valid State of Ohio driver's license
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.