- 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 Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Provider Network Manager - Costa Mesa, United States - Elevance Health
Description
Location:
we are targeting any of our California offices for this role, preferably Costa Mesa, CA but also open to Woodland Hills, Palo Alto, and Walnut Creek.
this position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 days per week.
The
Provider Network Manager
will develop the provider network through contract negotiations (language and rates), relationship development, and servicing.
Primary focus of this role is contracting and negotiating contract terms with recruitment and renewals for Medicaid FFS providers and support all lines of business Commercial, Medicare Advantage, & Medicaid for local Ancillary provider specialty networks.
Works with less-complex to complex providers processing applications from end-to-end related such as, reviewing application document, drafting contracting agreement, manage incoming emails and the point of contact for incoming emails from internal and external stakeholders, submitting request to load providers, review financial reportsProviders may include, but are not limited to, smaller institutional providers, professional providers, medical groups, physician groups, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required.
Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.Value based concepts understanding.
Fee schedules can be customized.
Works with increased independence and requires increased use of judgment and discretion.
May work on cross-functional projects requiring collaboration with other key areas.
Serves as a communication link between professional providers and the company.
Assists in preparing financial projections and conducting analysis as required.
Must have the ability to work independently and requires critical thinking to troubleshoot issues as they arise, detailed oriented, high level of judgement and discretion when working with providers, working negotiations and on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
Minimum requirements:
Requires a 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.
Preferred skills, capabilities, and experiences:
Proficient in word doc, excel
Strong communication skills
Detailed oriented
Analytical and critical thinking
Analyze financial report
Travels to worksite and other locations as necessary.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $70,576 to $96,240.
Locations:
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, non-discriminatory 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.