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Provider Network Manager Senior (US) - Location: Hybrid (ME, NH, MA, CT, RI, VT)

Anthem Blue Cross & Blue Shield

Anthem Blue Cross & Blue Shield

Connecticut, USA · Maine, USA · Massachusetts, USA · New Hampshire, USA · Rhode Island, USA
Posted on Wednesday, May 24, 2023

Position Title:

Provider Network Manager Senior (US) - Location: Hybrid (ME, NH, MA, CT, RI, VT)

Job Description:

Job Title: Provider Network Manager Senior

Location: Hybrid (ME, NH, MA, CT, RI, VT)

Responsibilities:

  • Develops the provider network through contract negotiations, relationship development, and servicing.
  • Primary focus of this role is contracting and negotiating contract terms.
  • Typically works with the most complex providers.
  • Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required.
  • Contracts involve non-standard arrangements that require a high level of negotiation skills.
  • Fee schedules are customized.

Primary duties may include, but are not limited to:

  • Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.
  • Works independently and requires high level of judgment and discretion.
  • May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management. May collaborate with sales team in making presentations to employer groups.
  • Serves as a communication link between professional providers and the company.
  • Ensure that network composition includes an appropriate distribution of provider specialties.
  • Conducts more complex negotiations and drafts documents. Prepare financial projections and conduct analysis.
  • May require travel up to 30%.

Minimum Requirements:

  • Requires a BA/BS degree
  • Minimum of 5 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Experience and Education:

  • Experience in fee schedule development using actuarial models strongly preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

PND > Network Contracting

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.