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From Home Provider Network Development Jobs in Ohio

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From Home Provider Network Development information

What are the key skills and qualifications needed to thrive as a from home provider network development professional, and why are they important?

To excel as a Provider Network Development professional working remotely, you need a solid understanding of healthcare provider relations, contract negotiation, and network management, often supported by a degree in healthcare administration or a related field. Familiarity with provider databases, CRM software, and managed care systems is typically required. Strong communication, relationship-building, and self-motivation are vital soft skills for effective remote collaboration and provider engagement. These abilities ensure efficient network growth, quality provider relationships, and organizational success in a virtual environment.

How does a from home provider network development professional typically collaborate with healthcare providers and internal teams?

As a remote Provider Network Development professional, you will regularly coordinate with healthcare providers through virtual meetings, emails, and phone calls to negotiate contracts and ensure compliance with network standards. Internally, you will work closely with credentialing, legal, and provider relations teams using collaboration tools such as shared databases and project management software. Effective communication and proactive outreach are essential to overcome the challenges of remote work and maintain strong professional relationships. You may also participate in regular virtual team meetings to align on goals, share updates, and resolve issues collaboratively.

What is a from home provider network development professional?

A From Home Provider Network Development job involves building and maintaining relationships with healthcare providers, such as doctors and hospitals, to expand or improve a healthcare network. Professionals in this role typically work remotely and are responsible for recruiting providers, negotiating contracts, and ensuring compliance with regulations. Their goal is to create a strong, accessible network that meets the needs of health plan members. This position requires skills in communication, negotiation, and knowledge of healthcare systems. Remote work allows for flexibility while still achieving important network development goals.

What is the difference between From Home Provider Network Development vs From Home Provider Relations Specialist?

AspectFrom Home Provider Network DevelopmentFrom Home Provider Relations Specialist
CredentialsHealthcare administration, network management certificationsCustomer service, healthcare communication certifications
Work EnvironmentRemote, healthcare provider offices, corporate officesRemote, healthcare provider offices, corporate offices
Employer & Industry UsageHealth insurance companies, managed care organizationsHealth insurance companies, healthcare providers
Search & Comparison IntentBuilding and managing provider networksMaintaining provider relationships and resolving issues

From Home Provider Network Development focuses on creating and expanding healthcare provider networks, requiring skills in network management and healthcare administration. In contrast, From Home Provider Relations Specialist emphasizes maintaining provider relationships and addressing provider concerns. Both roles are essential in healthcare organizations but differ in their primary focus and responsibilities.

What are the most commonly searched types of Provider Network Development jobs in Ohio? The most popular types of Provider Network Development jobs in Ohio are:
What are popular job titles related to From Home Provider Network Development jobs in Ohio? For From Home Provider Network Development jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching From Home Provider Network Development jobs in Ohio look for? The top searched job categories for From Home Provider Network Development jobs in Ohio are:
What cities in Ohio are hiring for From Home Provider Network Development jobs? Cities in Ohio with the most From Home Provider Network Development job openings:
From Home Provider Network Development jobs near you

VP Provider Network Management

Medical Mutual of Ohio

Cleveland, OH • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Medical Mutual of Ohio rating

8.6

Company rating: 8.6 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

89th of 301 rated insurance

Job description

Medical Mutual employees must submit their applications through MySource
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.
Job Summary:
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.
Responsibilities:
  • 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.

Qualifications:
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:
A Great Place to Work:
  • 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.

Excellent Benefits and Compensation:
  • 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 professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:
  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year, the IRS maximum.
  • Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
#LI-LS1 #LI-ONSITE
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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