Provider Network Manager Sr at Elevance Health, focusing on developing provider networks through complex negotiations and relationship management. Collaborating across teams to enhance network efficiency.
Responsibilities
Develops the provider network through contract negotiations, relationship development, and servicing.
Primary focus of this role is contracting and negotiating contract terms.
Works with the most complex providers.
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.
Conducts more complex negotiations and drafts documents.
Prepares financial projections and conduct analysis.
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.
Commercial Health plan experience strongly preferred
Experience negotiating capitated agreements
Experience negotiating large, complex health systems with various provider types such as ancillary, facility, physician
Experience in fee schedule development using actuarial models strongly preferred
Experience working in a fast-paced environment with critical deadlines
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