Provider Network Manager

Elevance Health•Grand Prairie, TX

23h•Hybrid

About The Position

The Provider Network Manager is responsible for developing the provider network through contract negotiations (language and rates), relationship development, and servicing in Texas. The primary focus of this role is contracting and negotiating contract terms, typically working with less-complex to complex providers. These providers may include smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals not part of a health system, and ancillary providers. The role involves working in areas with increased competition or where greater provider education around managed care concepts is required. Contracts may involve non-standard arrangements that require a moderate level of negotiation skills and an understanding of value-based concepts. Fee schedules can be customized. The position requires increased independence and the use of judgment and discretion, and may involve working on cross-functional projects requiring collaboration with other key areas. The Provider Network Manager also serves as a communication link between professional providers and the company, conducts more complex negotiations, drafts documents, and assists in preparing financial projections and conducting analysis as required.

Requirements

Requires a BA/BS degree.
Minimum of 3 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.
Candidates should reside within a commutable distance to one of Elevance Health's Pulse locations in Texas.
Become vaccinated against COVID-19 and Influenza (for new candidates in certain patient/member-facing roles).

Nice To Haves

Strong skills in researching and acquiring new providers for the network.
Ability to identify and address network gaps effectively.
Experience with contract and facility negotiations.
Background in behavioral health.
Data-driven approach with expertise in data research.
Experience maintaining significant provider contact.
Exceptional negotiation skills and experience in complex negotiations.
Strong experience in generating and analyzing reports to support decision-making.

Responsibilities

Develop the provider network through contract negotiations (language and rates), relationship development, and servicing in Texas.
Contract and negotiate contract terms with less-complex to complex providers, including smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, and ancillary providers.
Work with providers in areas with increased competition or where greater provider education around managed care concepts is required.
Handle non-standard contract arrangements that require a moderate level of negotiation skills.
Understand value-based concepts.
Customize fee schedules.
Work with increased independence and use judgment and discretion.
Work on cross-functional projects requiring collaboration with other key areas.
Serve as a communication link between professional providers and the company.
Conduct more complex negotiations and draft documents.
Assist in preparing financial projections and conducting analysis as required.