Provider Network Manager Sr (US)
About The Position
The Provider Network Manager Sr develops the provider network through contract negotiations, relationship development, and servicing. The role primarily focuses on contracting and negotiating contract terms, typically with the most complex providers, such as large institutional providers, large medical groups, and ancillary providers. This may involve value-based concepts, strong competition, or a need for additional provider education about managed care. Contracts may involve non-standard arrangements and customized fee schedules. The manager works independently, exercising a high level of judgment and discretion. The role also serves as a resource for contracting staff, providing mentoring and on-the-job training and development. It leads network management projects and cross-functional initiatives while managing a provider territory, complex contract negotiations, and ongoing provider relationships. The position may collaborate with the sales team on presentations to employer groups and serves as a communication link between professional providers and the company. This is a hybrid role requiring associates to work in-office one to two days per week, with alternate locations considered for candidates within commuting distance of an office. Travel to worksites and other locations may be necessary. The position is listed as Non-Management Exempt.
Requirements
- BA/BS degree and at least 5 years of experience in contracting, provider relations, or provider servicing, including prior contracting experience; or an equivalent combination of education and experience.
- High-level negotiation skills.
- Ability to work independently and exercise judgment and discretion.
- Ability to lead network management projects and cross-functional initiatives while managing provider relationships and complex negotiations.
Nice To Haves
- Experience developing fee schedules using actuarial models is strongly preferred.
- California provider contracting experience is preferred; provider contracting experience in other states will also be considered.
Responsibilities
- Develop the provider network through contract negotiations, relationship development, and servicing.
- Negotiate contract terms with complex providers, including non-standard arrangements and customized fee schedules.
- Serve as a key resource for contracting staff and provide mentoring, on-the-job training, and development.
- Independently lead network management projects and cross-functional initiatives while managing an assigned provider territory, complex contract negotiations, and ongoing provider relationships.
- Collaborate with the sales team on presentations to employer groups, as needed.
- Serve as a communication link between professional providers and the company.
- Ensure the provider network has an appropriate distribution of provider specialties.
- Conduct complex negotiations and draft documents.
- Prepare financial projections and conduct analysis.
- Travel to worksites and other locations as necessary.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
