Provider Network Manager

Blue Cross of Idaho•Meridian, ID

3d•$78,064 - $117,095•Remote

About The Position

Blue Cross of Idaho is looking for a Provider Network Manager be a part of the Provider Contracting team! This role will be responsible for the management, operation, direction, organization, and administration of hospital contracts. Ensure network contracts provide cost effective outcomes. Develop and maintain positive working relationships with contracted hospitals. Contract and negotiate with the most complex providers. Actively audit and monitor financial performance of all assigned hospitals to ensure accurate implementation and administration of contracts. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners. This position can be remote within a mutually acceptable location . #LI-Remote

Requirements

Minimum 4 years' provider contract management/network management, provider and hospital reimbursement methodologies, contract language negotiation, or relevant experience
Bachelor’s degree or equivalent work experience (Two years’ work experience is equivalent to one year of college)

Responsibilities

Develop the provider network through contract negotiations, relationship development, industry analysis and servicing.
Contract and negotiate with the most complex providers. Complex providers may include, but are not limited to, large hospital systems, large medical groups and ancillary providers, providers in areas where strong competition or greater provider education around managed care concepts is required.
Analyze, review, and project financial impacts of network contract arrangements.
Ensure accurate implementation and administration of executed network contracts and/or programs.
Implement reimbursement strategies designed to control healthcare costs.
Utilize data from multiple sources to recommend innovative payment initiatives and methodologies.
Serve as a communication link between providers and Blue Cross of Idaho
Prepare and present contract proposals and financial performance reports on assigned networks Hospitals to leadership.
Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements.
Prepare and present to healthcare organizations, clients, and internal business partners.
Establish productive, professional provider relationships with key stakeholders and maintains provider satisfaction through assessment and response to on-going provider needs.
May identify provider payment or utilization variations