Provider Network Manager Sr. at Elevance Health

Indianapolis, Indiana, United States

Elevance Health Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • 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
  • Experience in fee schedule development using actuarial models is strongly preferred

Responsibilities

  • Develops the provider network through contract negotiations, relationship development, and servicing, with primary focus on contracting and negotiating contract terms
  • Works with the most complex providers, including large institutional providers, large medical groups, ancillary providers, value-based concepts, providers in competitive areas, or where greater provider education on managed care is required
  • Handles contracts involving non-standard arrangements requiring high-level negotiation skills and customized fee schedules
  • Serves as key resource for other contracting staff, providing mentoring, on-the-job training, and development
  • Works independently, requiring high level of judgment and discretion
  • Works on projects impacting the business unit requiring collaboration with other key areas or serves on enterprise projects around network management
  • Collaborates with sales team in making presentations to employer groups
  • Serves as a communication link between professional providers and the company
  • Ensures that network composition includes an appropriate distribution of provider specialties
  • Conducts more complex negotiations and drafts documents
  • Prepares financial projections and conducts analysis
  • Travels to worksite and other locations as necessary

Skills

Key technologies and capabilities for this role

contract negotiationprovider relationsnetwork managementmanaged carevalue based contractsfee schedule developmentsales collaborationmentoring

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week in Indianapolis, Indiana, while providing flexibility for virtual work. Candidates not within a reasonable commuting distance from the posting location will not be considered unless an accommodation is granted.

What experience is required for the Provider Network Manager Sr. position?

A BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, or provider servicing is required, including prior contracting experience. Experience in fee schedule development using actuarial models is strongly preferred.

What are the main responsibilities of this role?

The role focuses on developing the provider network through complex contract negotiations, relationship development, and servicing, often with large institutional providers or in competitive areas. Duties include mentoring staff, collaborating on projects, conducting financial analysis, and ensuring appropriate network composition.

Is there a salary range listed for this position?

This information is not specified in the job description.

What makes a strong candidate for this Provider Network Manager Sr. role?

Strong candidates will have a BA/BS degree with 5+ years in contracting or provider relations, prior contracting experience, and preferably fee schedule development using actuarial models, along with high negotiation skills for complex providers.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees

Benefits

Medical, dental, & vision insurance
401(k) + match
Paid holidays
Paid Time Off
Incentive bonus programs
Stock purchase plan
Life insurance
Wellness Programs
Financial education resources
Adoption & Surrogacy Assistance
Dependent-care Flexible Spending Account (DCFSA)
Parental Leave
Parental Transition Week
Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.
Lawsuit against CMS over MA Star Ratings could lead to financial penalties.
CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.
Acquisition of CareBridge enhances home health services within Carelon division.
Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.
Predictive analytics support early disease detection, aligning with Elevance's whole health approach.
Telehealth expansion offers opportunities to reach more patients remotely.

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