Provider Network Manager Sr
Elevance Health

Job Info

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Provider Network Manager Senior

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Provider Network Manager Senior will be responsible for developing 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.

How you will make an impact:

• 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.
• Travels to worksite and other locations as necessary.

Minimum 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.

Preferred Skills, Capabilities, and Experiences:

• Experience in fee schedule development using actuarial models strongly preferred.
• Experience negotiating and overseeing commercial provider contracts highly preferred.
• Experience negotiating and overseeing Medicaid provider contracts preferred.
• Prior experience with contract management systems preferred.

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