Sr. Provider Network Manager

Elevance Health•Mesa, CA

5d•Hybrid

About The Position

Sr. Provi der Network Manager Primary Location: Costa Mesa, CA Additional Location(s): Denver, CO, Las Vegas, NV, Seattle, WA , Atlanta, GA, Lake Mary, FL Hybrid : This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. The Sr. Provider Network Manager develops the provider network through rigorous research, issue/gap identification, contract negotiations, relationship development, and servicing. Primary focus of this role is unit cost management via 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 groups and ABA 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. How you will make an impact: Projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management. Conducts more complex negotiations and drafts documents. Prepare financial projections and conduct analysis. 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 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. Travels to worksite and other locations as necessary.

Requirements

Requires a BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

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.
Strong experience conducting thorough research and applying well-reasoned judgment to inform decisions.
Experience building strong cross-functional relationships to ensure timely resolution of escalations.
Experience in fee schedule development using actuarial models strongly preferred.

Responsibilities

Projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
Conducts more complex negotiations and drafts documents.
Prepare financial projections and conduct analysis.
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 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.
Travels to worksite and other locations as necessary.