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Provider Enterprise Manager

5 months ago

Berea, United States OhioGuidestone Full time

Where New Paths Begin

OhioGuidestone is the state’s leader in community behavioral health care, serving around 26,000 Ohioans each year. We focus on the needs of the whole person by providing telehealth and in-person prevention services, as well as mental health and substance use treatment. As we help people navigate the most difficult times in their lives—with compassion and respect—we ultimately empower them to take steps towards a healthier future.

Essential Functions:

  • Demonstrate the values and guiding principles of OhioGuidestone every day, performing with the highest standards of excellence, integrity and ethics.
  • Direct day-to-day operations including ongoing review and evaluations of work activities, delegation of duties, and implementation of policies and procedures.
  • Analyze provider performance data to identify areas for improvement and implement strategies to enhance quality, efficiency and cost-effectiveness
  • Monitor key performance indicators (KPIs) and metrics to track the effectiveness of provider partnerships and identify opportunities for optimization
  • Collaborate with internal stakeholders, including operations, finance, and quality management teams, to drive performance improvement initiatives
  • Support the development, implementation, and coordination of programs and services that promote a positive patient experience
  • Prepare and monitor annual budget, analyze patterns, project expenditures and present reports to the leadership team.
  • Ensure timely and accurate insurance claim submission, patient statement generation and payment posting.
  • Manage all managed care relationships, including monitoring of related reimbursement, negotiation with third party payers, provider credentialing, and maintenance of contracts.
  • Ensure compliance with regulatory requirements and accreditation standards in all provider contracts and relationships
  • Collaborate with internal stakeholders, including operations, finance, and quality management teams, to drive performance improvement initiatives
  • Lead contract negotiations with providers to secure favorable terms and ensure alignment with organizational goals and objectives
  • Monitor contract compliance and performance, proactively addressing any issues or discrepancies that arise
  • Provide insights and recommendations based on market analysis, industry trends, and competitor activities to support informed decision-making
  • Lead, coach, and mentor assigned direct reports, as well as oversee and uphold performance standards and the level of accountability within the department
  • Collaborate with Human Resources to develop, implement, and maintain effective strategies for the recruitment and retention of a culturally diverse team;
  • Demonstrate positive leadership, promote an inclusive work environment and present the Agency in the most positive light with all internal and external contacts.
  • Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
Education & Experience:
  • Bachelor’s Degree in Healthcare Administration, Business Administration or related field; Master’s degree preferred
  • 5+ years’ experience in provider network management, contract negotiation, and relationship management within the healthcare industry
  • Demonstrated leadership abilities and experience managing cross-functional teams
Qualifications:
  • Mission driven; strong desire to make an impact
  • Strong understanding of healthcare regulations, reimbursement models, and accreditation standards
  • Ability to interpret, adapt, and apply protocols and procedures in a clinical setting including health information management, confidentiality, and safety.
  • Possess understanding of financial management including accounting, bookkeeping, billing, reimbursement, fee schedule management and purchasing.
  • Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
  • Ability to customarily and regularly exercise discretion and good professional judgment
  • Strong organizational skills; able to handle multiple priorities with strict attention to detail
  • Effective computer literacy skills, including Windows applications, Microsoft Office Suite, and electronic health records, etc.
  • Possess a valid Ohio Driver’s License with a safe driving record and valid insurance.
  • Successfully meet pre-employment drug screen, physical exam and tuberculosis test requirements.
  • Successfully meet all pre-employment background requirements.


Benefits include:
    • Competitive Salary
    • Free CEU trainings
    • Competitive medical benefits including a zero-cost monthly option for employee or employee + children
    • 10 paid holidays; three are exchangeable
    • Flexible work schedules to support work/life balance
    • Flexible work opportunities to support varying career paths, job roles, intern to hire, and locations
    • 401(k) with employer match option
    • Employment Assistance Program (EAP)
    • Mileage reimbursement
    • Free licensure supervision
    • Recognition and rewards

At OhioGuidestone we care about the health and safety of our employees. OhioGuidestone requires applicants to complete a pre-employment screening process upon receipt of an offer of employment. We require and cover the cost of a fingerprint background screening, physical, Tuberculosis test, and drug screen after an employment offer is made. Any employment offer is contingent upon receipt of all satisfactory pre-employment screenings.

Committed to creating a more diverse community, we encourage candidates from historically underrepresented groups to apply. EEO/M/F/H/V #LS-VS1