VP Provider Network Management

Description

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Provides executive leadership for the Company's provider network strategy, including provider contracting, network development, reimbursement strategy, and provider relationship management across physician, professional, institutional, and ancillary providers. Establishes and executes strategies that balance cost, access, quality, regulatory compliance, market competitiveness, and enterprise performance. Leads complex provider negotiations and ensures provider agreements, contracting practices, and reimbursement approaches are in alignment with corporate objectives, customer needs, and applicable government regulations.

• Leads the development, implementation, and administration of institutional, professional, and ancillary provider network strategies, including contracting, reimbursement, incentive, access, quality, and affordability strategies. Establishes policies and decision frameworks that optimize network value for customers, support provider performance, improve medical cost management, and advance corporate financial and strategic objectives.
• Provides executive direction and oversight for complex, high-impact provider contract negotiations, including review of proposed contract terms, approval of negotiation strategies, resolution of escalated issues, and alignment of concurrent negotiations with enterprise network, financial, compliance, and market objectives.
• Partners with Sales, Marketing, Product, Finance, Legal, and other enterprise leaders to support new business opportunities, retention efforts, customer inquiries, sales presentations, and RFP responses. Represents provider network strategy in customer-facing forums and ensures network capabilities, access, cost, and quality positioning are clearly aligned with market and customer needs.
• Provides executive leadership to provider network operations and related teams responsible for provider access, affordability, provider satisfaction, provider education, and operational performance. Sets priorities, allocates resources, monitors performance, and develops leadership capability to ensure the organization delivers effective provider network outcomes.
• Provides provider network leadership for new product development and implementation, ensuring network design, provider access, reimbursement strategy, regulatory requirements, and operational capabilities are considered early and aligned with enterprise growth, affordability, and customer objectives.
• Provides executive guidance on provider policy interpretation and resolution of escalated provider issues, including matters involving reimbursement, contract administration, provider relations, and customer impact. Represents the organization in high-level provider discussions and may deliver or sponsor education on reimbursement and network strategies.

Education and Experience:

• Bachelor's degree in Business or Health Care Administration or related field. Master's Degree preferred.
• 10+ years progressive experience in health care administration, provider contracting and/or managed care.
• 8 years experience in a progressive leadership capacity.

Technical Skills and Knowledge:

• Comprehensive knowledge of health care operations, the health insurance industry and provider network management processes and best practices.
• Strong knowledge of health plan regulations.
• Knowledge of health care products and Medicare/Medicaid.

Ability to regularly travel to offsite locations.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

• Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes…