Provider Network Manager Sr

Elevance Health • Columbus, GA

1d • Hybrid

About The Position

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.

Nice To Haves

• Commercial Health plan experience strongly preferred
• Experience negotiating capitated agreements
• Experience negotiating large, complex health systems with various provider types such as ancillary, facility, physician
• Experience in fee schedule development using actuarial models strongly preferred
• Experience working in a fast-paced environment with critical deadlines
• Data Analysis experience preferred
• Travels to worksite and other locations as necessary

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
• Prepare financial projections and conduct analysis

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees