Provider Network Manager Sr

Anticipated End Date:

Position Title:

Job Description:

Location:Listed CA Pulse Points only. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of the above Elevance Health PulsePoint locations.

Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration community and connection with the minimum inoffice commitment being 13 days in an office per week.

Candidates must reside within 50 miles or 1hour commute each way of the listed Elevance Health locations.

Develops the PPO 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 nonstandard arrangements that require a high level of negotiation skills. Fee schedules are customized.

PRIMARY DUTIES:

• Serves as key resource for other contracting staff and provides mentoring and onthejob 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.

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 Experience:

• Extensive knowledge and experience in the California healthcare market and regulatory environment particularly within PPO arrangements.
• Strong negotiation skills for successfully securing commercial and Medicare rate agreements with complex providers.
• Proven ability to manage and resolve legal contractual disputes ensuring compliance and maintaining network integrity.
• Expertise in overseeing provider noncompliance issues and managing escalations including postBreach of Contract Letter requests.
• Proficiency in data analysis and financial acumen for preparing projections and conducting indepth network performance assessments.
• Demonstrated ability to build and maintain strategic relationships with large medical groups and ancillary providers.
• Effective leadership and communication skills with experience in mentoring team members and presenting to varied stakeholders.

For candidates working in person or remotely in the below location the salary* range for this specific position is $98900 to $154800

Location: California

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate nondiscriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.

We offer a range of marketcompetitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.