Elevance Health - Chicago, IL

posted 11 days ago

Full-time - Mid Level
Chicago, IL
Insurance Carriers and Related Activities

About the position

The Provider Network Manager Sr. develops the provider network through contract negotiations, relationship development, and servicing. The primary focus of this role is contracting and negotiating contract terms, typically working with the most complex providers. Complex providers may include large institutional providers, large medical groups, ancillary providers, and those 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, and fee schedules are customized. The position will work in a hybrid model that includes one day per week in the office and visits to providers in Illinois up to 2-3 times weekly.

Responsibilities

  • Develop the provider network through contract negotiations and relationship development.
  • Serve as a key resource for other contracting staff, providing mentoring and on-the-job training.
  • Work independently with a high level of judgment and discretion.
  • Collaborate on projects impacting the business unit and serve on enterprise projects around network management.
  • Collaborate with the sales team in making presentations to employer groups.
  • Act as a communication link between professional providers and the company.
  • Ensure appropriate distribution of provider specialties in the network composition.
  • Conduct complex negotiations and draft necessary documents.
  • Prepare financial projections and conduct analysis.

Requirements

  • BA/BS degree and a minimum of 5 years' experience in contracting, provider relations, or provider servicing; experience should include prior contracting experience; or any combination of education and experience that provides an equivalent background.

Nice-to-haves

  • Knowledge of HealthLink contract components, or a combination of Commercial, Medicare, and/or Medicaid contract components.
  • Experience in fee schedule development using actuarial models.

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
  • Paid Time Off
  • Medical, dental, vision benefits
  • Short and long term disability benefits
  • Life insurance
  • Wellness programs
  • Financial education resources
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