Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Manager of Network Development:
This position is to actively oversee the education and service level of Meridian Health Plan’s (MHP) provider network to ensure it is capable of delivering all preventive, specialty and ancillary health services to MHP’s enrollees in its contracted service areas and lines of business.
- Manage the external Provider Network Development Representatives staff and monitor their daily activities through ongoing communication and periodic audits. Ensure sufficient frequency of meetings and communication to meet the needs of MHP and its providers. At a minimum, ensure monthly visits to each PCP office and facilitate quarterly meetings with Hospital Providers.
- Ensure that Provider Network Development Representatives are properly educated and able to complete their assigned tasks. Conduct random monthly field overviews with each Provider Network Development Representatives to ensure that a positive relationship is maintained.
- Manage provider complaints and grievances jointly with internal staff as necessary. Ensure that all provider concerns are addressed in a timely and thorough manner as described in the Provider Manual and all policies and procedures.
- Develop and implement an Orientation Program for all providers who meet the credentialing requirements and who are recommended for acceptance by the Credentialing Committee. The orientation should include:
- Complete education regarding applicable MHP policies and procedures including authorizations and referrals, claims/encounters, provider utilization reports and the complaint and grievance procedures
- Utilization of the MCS Provider Portal system as a tool to enhance the provider’s practice
- A review of the financial arrangements, including capitation or fee-for-service, covered services, reimbursement rates, payment schedules, bonus programs and risk sharing arrangements
- The process for reporting feedback to other MHP departments
- Coordinate the development and distribution of provider education information such as the Provider Manual, Provider Bulletins, Provider Newsletters, etc.
- Coordinate and oversee education and communication with providers related to quality improvement and outreach initiatives, such as lead screening, HEDIS, health fairs, disease management and other projects as necessary
- Ensure the effective and ongoing collaboration between the Provider Services Department and other MHP departments such as Member Services, Utilization Management, Quality Improvement, IT and Claims
- Represent the Provider Services Department at all weekly Appeal Committee Meetings, Monthly Manager/Director Meetings and additional internal Meridian Health Plan Meetings, as necessary. Attendance at all weekly Provider Service Department and Appeal Committee meetings is mandatory.
- Assist in preparing departmental information for State mandated site reviews and National Committee for Quality Assurance (NCQA), URAC, or general accreditation site visits, as necessary
- Perform other duties as assigned
What you can bring to Meridian:
- Bachelor’s degree in business administration, healthcare administration, communications, marketing or other related field is required.
- 3-5 years previous experience in a provider services role is preferred.
- Previous experience managing an external staff is preferred.
- Minimum of 4 years of progressive management experience is preferred.
- Thorough knowledge of MHP’s mission and its operational structure
- Thorough knowledge of basic reimbursement methods and rates
- Thorough knowledge of MHP’s provider policies and procedures as described in the Provider Manual
- Thorough knowledge of geographic areas in which MHP is licensed to operate, including types of providers in area, relationships between providers (PO, PHO, independent), key providers/decision makers, enrollee demographics and other competing health plans
- Knowledge of MHP’s reimbursement methods including Primary Care, Specialty Care, Ancillary Care, Hospital and Organizational Master
- Follow-up and follow-through skills
- Strong organizational skills
- Excellent communication and inter-personal skills
- Strong computer skills, including working knowledge of Microsoft Office and MHP’s Managed Care System
- Ability to communicate clearly and concisely both orally and via written documents
- Ability to work as part of a team while meeting and maintaining individual goals and objectives
- Ability to organize and manage other personnel
- Ability to travel within the state, with limited overnight travel required
What Meridian can offer you:
- Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer