What are the responsibilities and job description for the Provider Relations Network Manager - Ohio position at Mount Carmel Health System?
Employment Type
Full time
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.
Position Purpose
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 five 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!
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.
Full time
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.
Position Purpose
- Provider Relations & Network Manager is responsible for provider relations and service interactions including contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. Serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. Assists the Director, Provider Relations & Contracting in developing provider collaborations that ensure network growth and meet quality/efficiency targets.
- Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
- Serve as the MediGold point of contact within the Provider network.
- Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
- Engage Providers to develop, coordinate, and lead training and distribution of materials.
- Proactively drive communications with Providers via telephone/email and onsite visits.
- Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
- Negotiates provider contracts within MediGold guidelines and financial standards.
- Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
- Maintains excellent working relationships with MCHP's provider network, internal department management, other business partners, and Mount Carmel Health System related entities.
- Travel as required.
- Use of personal vehicle for Provider visits required.
- All other duties as assigned.
- Education: Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
- Experience: Minimum five years of experience with a Health Plan or Health Provider. Prior contracting and network development experience highly preferred
- Knowledge of physician claims coding and Provider reimbursement payment methodologies
- Ability to interpret Provider contracts
- Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
- Working knowledge of protocols and procedures of Centers for Medicare and Medicaid Services
- Valid driver's license
- Requires use of a personal vehicle with valid auto insurance.
- Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
- 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 starting on day one.
- RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
- Relocation assistance (geographic and position restrictions apply).
- 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.
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 five 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!
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.