National Labor Exchange Veterans Jobs

nlx logo

Search Jobs from Veteran Friendly Employers

Job Information

Anthem Provider Network Management Director - CA Only - Remote or Office Based - PS24899 in Long Beach, California

Provider Network Management Director - CA Only - Remote or Office Based - PS24899

Location: California, United States

Requisition #: PS24899

Post Date: Aug 22, 2019

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

Provider Network Management Director

Location: California

The Provider Network Management Director develops the provider network through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, ancillary, hospitals and IPAs (not just one of these provider types). Primary focus of this role is contracting and negotiating contract terms utilizing multiple payment methodologies, including value based payments. Spends a minimum of 50% of the time as subject matter expert and deals with only the most complex providers. Primary duties may include, but are not limited to:

  • Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.

  • Typically serves as lead contractor for large scale, multi-faceted negotiations.

  • Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.

  • May assist management in network development planning.

  • May be involved in associate development and mentoring.

  • Works with the most complex providers such as institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition.

  • Contracts involve non-standard arrangements that require a high level of negotiation skills.

  • Fee schedules are typically customized.

  • 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.

  • Serves as a communication link between professional providers and the company.

  • Conducts the most complex negotiations.

  • Prepares financial projections and conducts analysis.

  • Requires a BA/BS degree; 8-10 years experience in contracting, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires 20% statewide travel.

  • CA managed care provider market strongly preferred.

  • Capitated medical negotiations and hospital negotiations strongly preferred.

  • Real-time negotiation and contracting experience required.

  • Strong written and verbal communications skills.

  • Must live in California.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran