Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Network Development Representative - Champaign/Urbana

Expired Job

Meridian Champaign , IL 61822

Posted 3 months ago


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 Provider Network Development Representative:

This position is to create an educated and comprehensive provider network in all assigned territories.


  • Prospecting to potential providers for inclusion in the Meridian's Provider Network for all lines of business

  • Coordinating the entire contracting process for all potential providers, including prospecting, negotiation, credentialing and orientation

  • Collecting all practitioner and ancillary signed contracts, applications and necessary credentialing information. Ensuring Meridian's credentialing standards are maintained

  • Full understanding of all provider reimbursement and methodologies

  • Educating providers on Meridian's provider policies and procedures

  • Increasing HEDIS scores in the assigned territory

  • Occasional special projects related to provider development and education

  • Provider network reporting for State expansion requirements

  • Assist contracted Meridian's providers with access to the Provider Portal. Provide ongoing education on the use and tools of the Provider Portal

  • Provide exceptional customer service to our Provider Network

  • Complete change forms and top sheets when needed to update Provider changes an or additions in MCS (complete and submit appropriate documentation for proper set up in MCS)

  • Assisting with planning and development activities related to network capacity

  • Provide training and mentoring for Provider Network Development Representatives in other states

  • Assisting with problem resolution related to provider claim, authorization and other issues

  • Perform other duties as assigned


What you can bring to Meridian

  • Bachelor's degree required

  • One year of managed care experience required.

  • Two years of managed care experience preferred.

  • Knowledge of Meridian's philosophy, organizational structure and plan overview

  • Knowledge of Meridian's Practitioner, Hospital and Ancillary Agreements

  • Knowledge of Meridian's credentialing requirements for all providers

  • Knowledge of managed care reimbursement methods

  • Knowledge of Medicaid managed care, included but not limited to the applicable State guidelines, reimbursement and competitors

  • Knowledge of Meridian's provider manual, including policies and procedures

  • Computer skills, including advanced knowledge of Excel, Word, and Oracle/Dashboard software

  • Proven exemplary problem solving ability

  • Follow up skills, with a "do whatever it takes" attitude

  • Organizational skills

  • Presentation skills

  • Ability to communicate clearly and concisely both orally and in writing

  • Ability to work as part of a team while maintaining and exceeding individual goals and objectives

What Meridian can offer YOU:

  • Our healthcare benefits include a variety of PPO 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 MHP employees are eligible for tuition reimbursement towards Bachelor's or Master's degrees.

  • Meridian's Chicago location is conveniently located in the Chicago Loop, and provides commuting benefits including discounts for public transportation and parking structures

  • Regular activities such as sports leagues, "mix 'n' mingle" events, and volunteer opportunities take place in neighborhoods throughout the city

  • Meridian is an Equal Opportunity Employer

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Market Manager Champaign Area

Circle K Stores, Inc.

Posted 4 days ago

VIEW JOBS 12/11/2018 12:00:00 AM 2019-03-11T00:00 Job Description Circle K is a great place to work! Here is why: We know that you can work anywhere. However, working at Circle K is the start of something great! While you make it easy for our customers, we focus on you and your development! Our people make us who we are. We want to see you grow, so we put growing together at the forefront of everything we do. It is our duty to provide you with the tools and resources that you need to succeed. Joining Circle K means joining a team that is devoted to you! Essential Functions: 1. Maximizes store sales through excellent customer service, product availability, and merchandising and exceptional store image inside and out. 2. Provides information to store management by recapping promotional activity; reporting business opportunities, results, trends and competitive information. 3. Manages controllable costs by educating managers on procedures for controlling merchandise variation, managing salaries, overtime, cash, repair and maintenance costs. 4. Collaborates with Marketing team to ensure promotions and new product introductions are fully implemented. Provide feedback to category managers regarding stock issues. 5. Partners with vendors to ensure product is available. Timely execution of monthly promotions. Ensure vendor's performance and behavior is professional. 6. Ensures store operations are profitable by managing cash and merchandise variation, salaries, and other controllable expense lines on the P&L. 7. Ensures compliance with requirements by enforcing adherence to policies and procedures, and government regulations; enforces and monitors restricted sales policies; advises management of needed actions. 8. Protects employees, customers and company assets by maintaining a safe and secure working environment; enforcing safety practices; providing safety communication and training. 9. Achieves financial objectives by forecasting requirements, preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions. 10. Provides leadership and direction to store managers, including assistance in recruiting, selection, and orientation processes, assists with employee development and training programs; planning, monitoring and appraising job results. Establishes job expectations. Provides coaching to develop action plans for issue resolution. Administers counseling notices; initiates corrective actions. Implements non-discriminatory related management skills while hiring, training, counseling, motivating and separating employees. 11. Adheres to the Company Operating Policy of Legal, Ethical, and Moral practices. 12. Enhances professional and technical knowledge by attending educational workshops; reading professional publications; establishing personal networks; or participating in professional societies. 13. Contributes to team effort by accomplishing Financial and Key Result Area targets pursuant to Company plan guidelines. Qualifications 1. Bachelor's degree in business or related field preferred. Other combinations of job related experience and education that meet the requirements may be substituted. 2. Three to five years of retail business experience or more preferred; including minimum of two years of management responsibility. 3. Must have demonstrated leadership ability, good communication skills, be self-directed, self-motivated and customer service oriented. Ability to communicate (orally and in writing) in English. 4. Ability to supervise and train Store Managers in use of store equipment, tools and materials. Ability to supervise and manage the functions listed in the SM job description. 5. Expertise with MS Outlook, Excel, PowerPoint and Word preferred. 6. A current valid driver's license is required to operate a company vehicle. Physical Requirements: The physical requirements described here are examples of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be considered that might assist those individuals with disabilities in order to perform the essential task and duties. While performing the duties of this job, the employee is regularly required to sit, talk and/or hear. The employee frequently is required to use his/her hands in order to handle or grasp items of varying weight. The employee is occasionally required to stand, walk, and reach with both hands and arms. The employee may also be required to: Occasionally lift and/or carry, up to 60 pounds from ground to waist level for up to 30 minutes of a workday. (I.e. to replenish fountain syrups). Occasionally lift and/or carry up 30 pounds from the ground to overhead up to 30 minutes a workday. (I.e. stocking/maintaining inventory levels; resets.) Occasionally lift and/or carry up to 40 pounds from the ground to waist up to 30 minutes a workday. (I.e. stocking/maintaining inventory levels; resets) Ability to push and pull with arms up to a force of 20 pounds. (i.e. utilizing a hand truck). Ability to climb a ladder to store or retrieve materials, place and/or replace signage. Work Environment: The work environment described below is an example of those an employee will experience while performing the essential functions of this job. Reasonable accommodations will be considered that might assist those individuals with disabilities to perform the essential tasks and functions of their job. The noise level in the work environment is usually moderate at a normal range. The lighting will include natural light from the outside as well as fluorescent lighting throughout the work areas. The temperatures in the store are usually moderate at a normal range. The individual may occasionally exposed to extreme temperatures while supervising store managers performing occasional work in a walk-in cooler and/or freezer. This position may also require 50% travel by car. THE ABOVE STATEMENTS REFLECT THE GENERAL QUALIFICATIONS / DUTIES AND /OR RESPONSIBILITIES NECESSARY TO IDENTIFY THE JOB AND ARE NOT NECESSARILY INTENDED TO SET FORTH ALL OF THE SPECIFIC REQUIREMENTS OF THE JOB. NOTE: This Job Description may change periodically as required by business necessity, with or without advance notice to employees. Circle K is an Equal Opportunity Employer. The Company complies with the Americans with Disabilities Act (the ADA) and all state and local disability laws. Applicants with disabilities may be entitled to a reasonable accommodation under the terms of the ADA and certain state or local laws as long as it does not impose an undue hardship on the Company. Please inform the Company's Human Resources Representative if you need assistance completing any forms or to otherwise participate in the application process. Click below to review information about our company's use of the federal E-Verify program to check work eligibility: In English In Spanish Circle K Stores, Inc. Champaign IL

Network Development Representative - Champaign/Urbana

Expired Job