Provider Network Manager Sr

Elevance Health•Denver, CO

6d•Remote

About The Position

The Provider Network Manager Sr 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 and customized fee schedules. Serve as key resource for other contracting staff and provides mentoring and on-the-job training and development. Work 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. Serve as a communication link between professional providers and the company. Ensure that network composition includes an appropriate distribution of provider specialties. Conduct more complex negotiations and drafts documents. Prepare financial projections and conduct analysis. Travel to worksite and other locations as necessary.

Requirements

BA/BS degree and a minimum of 5 years of experience in contracting, provider relations, provider servicing.
Prior contracting experience.
Combination of education and experience which would provide an equivalent background.

Nice To Haves

Experience in fee schedule development using actuarial models strongly preferred.
Strong project management skills.
Comprehensive negotiation skills supporting multi-service lines of business.

Responsibilities

Develops the provider network through contract negotiations, relationship development, and servicing.
Focuses on contracting and negotiating contract terms.
Works with complex providers, including large institutional providers, large medical groups, and ancillary providers.
Supports value-based concepts and provides education on managed care concepts.
Negotiates non-standard arrangements with customized fee schedules.
Serves as a key resource and mentor for other contracting staff.
Works independently with a high level of judgment and discretion.
May work on projects impacting the business unit or serve on enterprise projects.
Acts as a communication link between professional providers and the company.
Ensures appropriate distribution of provider specialties within the network.
Conducts complex negotiations and drafts documents.
Prepares financial projections and conducts analysis.
Travels to worksite and other locations as necessary.