Provider Network Manager (US)

Elevance Health • Las Vegas, NV

1d • Hybrid

About The Position

The Provider Network Manager develops and services provider networks through contract negotiations, relationship development, and ongoing provider support. The role manages assigned California PPO provider territories, with a primary focus on negotiating contract terms, including fee-for-service rates, and shaping provider contracting strategy.

The manager resolves complex provider contracting and reimbursement issues in partnership with cross-functional teams. The role supports a range of providers, negotiates some non-standard arrangements, applies value-based concepts, customizes fee schedules, drafts documents, and assists with financial projections and analysis. It also involves cross-functional project work, serving as a communication link between professional providers and the company, and traveling to worksites and other locations as necessary.

This hybrid role requires in-office work one to two days per week. Candidates generally need to live within commuting distance of an office, subject to applicable accommodations.

Requirements

• A BA/BS degree and a minimum of 3 years of experience in contracting, provider relations, or provider servicing, or an equivalent combination of education and experience.
• Moderate negotiation skills for contracts that may involve non-standard arrangements.

Responsibilities

• Develop the provider network through contract negotiations, relationship development, and servicing.
• Maintain a primary focus on contracting and negotiating contract terms.
• Manage assigned California PPO provider territories, including fee-for-service rate negotiations, provider contracting strategy, relationship management, and ongoing network needs.
• Lead resolution of complex provider contracting and reimbursement issues with cross-functional teams, including rate and contract discrepancies, provider escalations, implementation issues, and remediation efforts affecting PPO providers.
• Support contracting for providers such as institutional providers, professional providers, medical and physician groups, small hospitals not affiliated with a health system, and ancillary providers.
• Negotiate contracts that may involve non-standard arrangements.
• Apply value-based concepts and customize fee schedules as needed.
• Work with increased independence and exercise judgment and discretion.
• Participate in cross-functional projects requiring collaboration with other key areas.
• Serve as a communication link between professional providers and the company.
• Conduct complex negotiations and draft documents.
• Assist in preparing financial projections and conducting analysis as required.
• Travel to the worksite and other locations as necessary.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short- and long-term disability benefits
• 401(k) with company match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level