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Provider Network Management Director

Anthem Blue Cross & Blue Shield

Anthem Blue Cross & Blue Shield

London, UK · California, USA · North Carolina, USA · Wisconsin, USA · Utah, USA · Tennessee, USA · South Carolina, USA · Texas, USA · Rhode Island, USA · Washington, DC, USA · Pennsylvania, USA · Oregon, USA · Ohio, USA · North Dakota, USA · Nevada, USA · New Hampshire, USA · Wyoming, USA · Nebraska, USA · Montana, USA · Missouri, USA · Minnesota, USA · Massachusetts, USA · Michigan, USA · Idaho, USA · Maine, USA · Maryland, USA · Indiana, USA · Illinois, USA · Iowa, USA · Georgia, USA · Florida, USA · Arizona, USA · Alabama, USA · Remote
Posted on Thursday, October 26, 2023

Position Title:

Provider Network Management Director

Job Description:

Provider Network Management Director

Location: This role will work a hybrid model (remote and office). Must reside within 50 miles or 1-hour commute of an Elevance Health location.

The Provider Network Management Director develops the provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups including employed and hospital based and hospital owned ancillary providers. Primary focus of this role is contracting and negotiating contract terms with national Ambulatory Surgery Centers and national Urgent Care Centers. Deals with only the most complex providers and drives and supports value-based initiatives.

How you will make an impact:

  • Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.
  • Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.
  • Typically serves as lead contractor for large scale, multi-faceted negotiations.
  • Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
  • May assist management in network development planning.
  • May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
  • Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are customized.
  • 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 providers and the company.
  • Conducts the most complex negotiations.
  • Prepares financial projections and conducts analysis.

Minimum Requirements:

  • Requires a BA/BS degree and a minimum of 8 years’ experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Experience using financial models and analysis to negotiate rates with providers strongly preferred.
  • Experience with Ambulatory Surgery Center and Urgent Care Center provider contract negotiations and servicing.
  • Travels to worksite and other locations as necessary.

Job Level:

Director Equivalent

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.