Medicaid Provider Relations Manager

Requisition ID: 875544 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same.  And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.  In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands.  Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

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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