Provider Network Manager Senior

Elevance Health•Portland, ME

2d•Hybrid

About The Position

The Provider Network Manager Senior 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.

Requirements

Requires a BA/BS degree and a 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.
Strong communication skills, both oral and written.

Nice To Haves

Experience in fee schedule development using actuarial models strongly preferred.
Managed care experience working in a relationship-building role with providers strongly preferred.
Experience with Commercial and Medicare lines of business strongly preferred.
Understanding of value-based concepts preferred.
Claims and/or administrative role within provider operations preferred.
Experience with digital tools preferred.
JD or MBA preferred.
Previous health insurance or healthcare provider experience is strongly preferred.

Responsibilities

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.
Contracts may involve non-standard arrangements that require a high level of negotiation skills.
Prepare financial projections and conduct analysis.