Provider Network Manager (US) at Elevance Health

Woodland Hills, California, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience which would provide an equivalent background
Ability to travel to worksite and other locations as necessary
Provider billing and coding experience preferred
Single Case Agreement experience preferred
Must be within a reasonable commuting distance from the posting location(s) (unless an accommodation is granted as required by law)

Responsibilities

Develops the provider network through contract negotiations (language and rates), relationship development, and servicing
Primary focus on contracting and negotiating contract terms with less-complex to complex providers (e.g., smaller institutional providers, professional providers with complex contracts, medical groups, physician groups, small hospitals not part of a health system, ancillary providers, providers in competitive areas or requiring managed care education)
Handles contracts involving non-standard arrangements requiring moderate negotiation skills
Customizes fee schedules
Works with increased independence, using judgment and discretion
Works on cross-functional projects requiring collaboration with other key areas
Serves as a communication link between professional providers and the company
Conducts more complex negotiations and drafts documents
Assists in preparing financial projections and conducting analysis as required

Skills

contract negotiation

provider relations

contract drafting

financial projections

negotiation skills

relationship development

managed care

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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