Description
Medical Mutual employees must submit their applications through MySource.
This is a hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week.
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:
Provider-Focused Liaison serves as a strategic partner to key providers and internal provider teams, supporting the advancement of care management and population health initiatives. Responsible for driving improvements in quality, cost performance, and member outcomes through consultative collaboration. Assists in the development, coordination, and implementation of clinical and strategic initiatives, aligning provider efforts with organizational goals and value-based care models.
Responsibilities:
- Collaborates with providers and health systems to implement programs that improve care quality and reduce costs for at-risk populations.
- Executes clinical initiatives to align with strategic and contractual goals through Cross-Functional Collaboration (CQHS, Sales, Marketing, Provider Network, etc.).
- Monitors and interprets Clinical program data to identify trends in medical utilization and clinical outcomes.
- Analyzes clinical cases and prepares documentation for case conferences with care management and population health teams.
- Builds and maintains clinical relationships through regular meetings and communication.
- Participates in divisional events and initiatives that support the organization's strategic plan.
- Performs other duties as assigned.
Qualifications:
Education and Experience:
- Graduate of a registered nursing program approved by the Ohio State Nursing Board.
- Bachelor's Degree preferred. In lieu of RN, Bachelor's degree in business or health care administration or related field.
- Masters degree preferred.
- 5 years experience partnering with provider groups, health systems, and/or employer groups to advance clinical initiatives or equivalent relevant experience in the healthcare or health insurance industry.
Professional Certification(s):
- Registered Nurse with current State of Ohio unrestricted license preferred.
Technical Skills and Knowledge:
- Comprehensive knowledge of healthcare cost drivers and factors impacting participant satisfaction.
- Comprehensive knowledge of population health and/or value-based care concepts
- Knowledge of health insurance regulations (Centers for Medicare & Medicaid Services (CMS), State of Ohio) and National Committee for Quality Assurance (NCQA)
accreditation guidelines. - Strong project management skills.
- Strong written and verbal communication and presentation skills. Intermediate to advanced Microsoft Office skills.
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:
- We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
- Whether you are working remote or in the office, 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.
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