Provider Network Management Director

Elevance Health•Woodland Hills, CA

23h•Hybrid

About The Position

The Provider Network Management Director develops the California provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups, including employed, hospital-based, and hospital-owned ancillary providers. The primary focus is contracting and negotiating contract terms for complex health systems and affiliated providers, while driving and supporting value-based initiatives. This director serves in a leadership capacity, leading associate resources, special projects, initiatives, or network planning. The role may provide work direction and set priorities for field staff, and may contribute to associate development and mentoring. It serves as a subject matter expert for local contracting efforts or specialized contracting components, and typically leads large-scale, multifaceted negotiations involving non-standard arrangements and customized fee schedules. The position works independently with substantial judgment and discretion, represents the business unit on enterprise network-management initiatives, and leads projects with significant impact. It may assist with network development planning, collaborate with sales on presentations to employer groups, and serve as a communication link between providers and the company. The director prepares financial projections, conducts analysis, and travels to worksites and other locations as necessary. The role is hybrid and requires associates to work in-office three days per week. Preferred locations are Woodland Hills, Costa Mesa, or Walnut Creek, California; other locations may be considered for candidates within commuting distance of an office. Candidates must be able to work Pacific Time hours.

Requirements

BA/BS degree and at least 8 years of experience in contracting, provider relations, or provider servicing, including prior contracting experience; an equivalent combination of education and experience is also acceptable.
Ability to work Pacific Time hours.
Ability to work in-office three days per week and reside within commuting distance of an Elevance Health office, unless an accommodation is granted.
High-level negotiation skills and judgment to independently handle complex, non-standard contract arrangements and customized fee schedules.

Nice To Haves

California provider contracting experience.
Five or more years of experience supporting hospital systems.
Experience negotiating contracts with hospitals, health systems, large physician groups, or ancillary providers.
Experience in managed care, health plan, or provider network environments.
Experience using financial models and analysis to negotiate provider rates.
Experience providing enterprise-wide support across Commercial, Medicaid, and Medicare lines of business.
Demonstrated experience leading high-impact provider negotiations.
Experience customizing provider fee schedules.
Knowledge of healthcare claims processing and reimbursement methodologies.

Responsibilities

Develop the California provider network through contracting, relationship development, and provider servicing.
Negotiate contract terms with complex health systems, affiliated physician groups, and ancillary providers.
Drive and support value-based initiatives, including contracting related to shared savings and ACO development.
Lead large-scale, multifaceted negotiations and serve as a lead contractor for complex deals.
Lead associate resources, special projects, initiatives, or network planning; provide work direction and priorities for field staff as needed.
Serve as a subject matter expert for local contracting efforts or specialized components of the contracting process.
Represent the business unit on enterprise network-management initiatives and lead projects with significant impact.
Assist management with network development planning and contribute to associate development and mentoring as needed.
Prepare financial projections and conduct analysis to support negotiations and network decisions.
Collaborate with sales teams on presentations to employer groups.
Act as a communication link between providers and the company.
Travel to worksites and other locations as necessary.