Provider Network Management / Contracting Director (Quality-Based)
Elevance Health

Description

Provider Network Management / Contracting Director (Quality-Based) (JR75415)

Location : Must reside in California within commuting distance to one of our offices in Cerritos, Costa Mesa, Los Angeles, Palo Alto, Rancho Cordova, Sacramento, Walnut Creek, or Woodland Hills.

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 for medical groups, IPA's and hospitals within Commercial, Medicare, and Medicaid lines of business. Deals with only the most complex health systems, affiliated providers and drives and support value based initiatives. Primary duties may include, but are not limited to:

• 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 or for a business unit.
  
• Develops innovative ways to maintain a cost-effective network with adequate access and positive working relationships with providers.
  
• Drive successful execution of all business initiatives and communicate regular updates across multiple stakeholders.
  
• Partner with the business stakeholders to define new incentive programs, business' strategy and successful criteria for performance execution and measurement.
  
• Lead the business' planning process, translating strategy into defined tactics, program / project priorities, and timelines to ensure achievement of business strategic goals.
  
• Coordinate Business Operating Reviews, including setting cadence, preparing materials, and managing follow-up action items.
  
• Work with the business' regions and markets to ensure initiatives are effectively managed through portfolio management tactics, including KPIs and other success metrics.
  
• Support the strategic evaluation, planning and / or execution of new value-based programs. Responsible for supporting data-gathering and assisting in implementation, etc.
  
• Typically serves as lead contractor for large scale, multi-faceted, complex negotiations.
  
• Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
  
• 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.
  
• Requires collaboration with key areas and serves 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.
  
• Prepares financial projections and conducts analysis.
  

Minimum Requirements:

• 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 Qualifications:

• Experience using financial models and analysis to negotiate rates with providers strongly preferred.
  
• Experience negotiating complex healthcare contracts (within managed care or provider industry.)
  
• Growth mindset, adaptability and high situational awareness.
  
• Exceptional written and oral communications skills and a refined skill in tailoring messages to specific audiences in their preferred channels.
  
• Experience in executive level advising and cross-functional collaboration.
  
• Excellent leadership, financial, and analytical skills.
  
• Strategic thinker with broad and deep understanding of the health care industry.
  
• Sets compelling goals for execution skills in driving towards these goals.
  
• Is action-oriented and hands-on, with demonstrated experience in an innovative, fast-paced, performance-oriented environment.
  
• Is highly articulate when communicating and engenders credibility.
  
• Influences across all levels of the organization, from staff to the executive level.
  
• May require travel up to 30%.
  

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $107,448 to $175,824.

Locations: California.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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.

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.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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