Job Description
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Manager - Provider Relations (Medicaid Contracting and Network) At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.
Our mission is to help people see life to the fullest—and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.
EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.
GENERAL FUNCTION
The Manager – Provider Relations (Medicaid Contracting and Network) is responsible for developing and implementing the Network and Contracting needs as they relate to Medicaid & Medical/Surgical plans. The Manager will support projects, analytics, and day to day management of EyeMed’s Medicaid & Medical/Surgical networks. The Manager is responsible for partnering with internal constituents on strategic Provider Relations initiatives to ensure the EyeMed Provider Agreement and associated fee schedules support the objectives of those initiatives. The Manager will be responsible for supporting data analysis and providing recommendations to leadership to support EyeMed Provider Escalations, Strategic Recruiting efforts, Custom Network builds and overall provider economics.
MAJOR DUTIES AND RESPONSIBILITIES
Oversee data analysis of Medicaid & Medical/Surgical networks and develops recommendations for high priority Provider Relations projects and initiatives related to Network Strategy and Provider Economics. Ensure recommendations align with organizational goals and other key stakeholder’s objectives.
Maintains knowledge of state Medicaid contract requirements so to serve as a resource to internal and external stakeholders.
Supports research of Medicaid state requirements and regulations
Work closely with Provider Communications, Provider Experience, and Call Center teams to ensure Network Strategy initiatives are supported with appropriate provider communications and interactions.
Identify opportunities for network simplification and work with internal stakeholders to implement recommendations.
Collaborate with Sales and Account Management team to intake, analyze, and provide recommendations on Strategic Provider needs and Custom Network Builds
Partner with Configuration & Operations teams to launch new networks to support strategic client needs
Establish and maintain regular leadership dashboards on Network Management, Network Health, and Provider Economics
Lead efforts and provide recommendations to leadership on Provider Escalations, including but not limited to Reimbursement increases, Network adds, and Change of Ownership.
Collaborate with Contracting and Operations teams in planning and design of contract management system enhancements
Support departmental collaboration with Legal, Finance, Pricing, Operations, and Compliance to ensure understanding and compliance with Provider Agreement and associated Fee Schedules
BASIC QUALIFICATIONS
Bachelor’s Degree or equivalent work experience
5+ years of experience in business strategy, operations, contract management, or other related field
Experience with Medicaid programs
Demonstrated success in problem solving, collaboration and communication
Able to identify obstacles quickly and develop solutions that support the business
Strong organizational and time management skills
Strong critical thinking and data analysis skills
Strong oral and written communication skills
Advanced knowledge of Microsoft Office
PREFERRED QUALIFICATIONS
Experience in the healthcare industry / provider relations
Knowledge and understanding of plan benefit designs, standards of administration, etc.,
Self-motivated and works independently with minimal supervision
Experience leading resolution to cross-functional issue resolution
Business Objects reporting experience
Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.
Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.
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Job Tags
Minimum wage, Contract work, Work experience placement, Work at office, Local area,