Provider Network Manager JR96161
Location : Must reside within 50 miles/1 hour commute to one of the following offices: Woodland Hills, Walnut Creek, Costa Mesa, or Palo Alto. (Woodland Hills preferred.)
- Note this is part of our Hybrid Workforce Strategy and will require 1 - 2 days/week working in the local office.
The Provider Network Manager
develops the provider network through contract negotiations (language and rates), relationship development, and servicing. 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 for value based arrangements. Typically works with less-complex to complex providers including, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required.
- Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.
- Value based concepts understanding.
- Fee schedules can be customized.
- Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process for Value Based arrangements and serves as business unit representative on enterprise initiatives around network management
- Works with increased independence and requires increased use of judgment and discretion.
- Leads special projects/initiatives, or network planning.
- May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
- 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.
- Develops innovative ways to maintain a cost-effective network with adequate access and positive working relationships with providers.
- Support the strategic evaluation, planning and / or execution of new value-based programs.
- Responsible for supporting data-gathering and assisting in implementation, etc.
- Drive successful execution of all business initiatives and communicate regular updates across multiple stakeholders.
- May work on cross-functional projects requiring collaboration with other key areas.
- Serves as a communication link between professional providers and the company.
- Conducts more complex negotiations and drafts documents.
- Assists in preparing financial projections and conducting analysis as required.
- BA/BS degree and a minimum of 3 years' experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.
- Travels to worksite and other locations as necessary.
- Experience using financial models and analysis to negotiate rates with providers strongly preferred.
- Experience negotiating complex healthcare contracts (within managed care or provider industry.)
- 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 location, the salary* range for this specific position is $73,600 to $115,200.
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 for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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. Unless 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 an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 firstname.lastname@example.org assistance.
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