Manager, Provider Network Development - Convent Station, United States - Zelis Healthcare

Zelis Healthcare Convent Station, United States

2 weeks ago

Description

Po s

iti on O v e r

v

i ew

Responsible for the overall strategy and development of Zelis contracted network providers (current and prospective) in an effort to increase the savings achieved for Zelis clients for existing and new products.

Cultivate organization's' overall direct contracted PPO assets to support multiple products and achieve corporate objectives for PPO product viability.
S u mma r y of

R e s

p o n

s

i

b

i l iti es
Serve as a resource for all providers in a variety of markets, in particular large and key strategic groups and health systems, and national arrangements
Negotiates complex contracts and coaches contracting team for network development efficiency.
Executes corporate contracting strategy for multiple product lines (primary, OON, government, workers compensation, etc).
Establish strategic relationships with all types of providers
Answer complex questions and provide information about procedures or contracts
Assist business operations with contract terms and educating company key personnel about such contract terms
Develops and provides plan support and contracting leadership, as required.
Compiles, maintains, and analyzes provider and hospital fee schedules to identify cost savings opportunities.
Develops and communicates network development goals including target acquisitions, claim dollars captured, and revenue achieved.
Provide continuous feedback and updates to organization's direct contract strategy.
Create and manage tools necessary to capture provider targets, measure performance and provide feedback and recommendations to executive team.
Recruit, coach and mentor Network Development staff.

Initiates and effectively communicates a variety of human capital related actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.

Performs other duties as required.
S u mma r y of

Qu al i f i ca ti o n s
Bachelor's degree or equivalent experience.
Advanced understanding of contract language and can explain according to audience

In-Depth level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

In-Depth knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs.
In-Depth knowledge of managed care policy and direction.
Strong knowledge of product lines including group health, workers compensation, dental and government business.
Management of strategic operational and technology initiatives.
Strong working knowledge of MS Excel, computer systems, applications and operating systems.
Experience managing projects and process innovative changes effectively.

EXPERIENCE
Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
Demonstrated thought leadership and motivation skills
Self-starter
Ability to research and resolve
Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.g., partnering, conflict management, consulting, etc.)
Must be available to travel 25% - 50% as required to meet business needs.
Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
Relocation assistance is provided for this position.
work environment

A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.

A standard business environment exists with moderate noise levels.
Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
Ability to sit for extended periods of time.

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members.

We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all.

We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care.

Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity,Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations.

We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work.

We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer.

All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email

SCAM ALERT:

There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams.

This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process.

Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.

#J-18808-Ljbffr

Manager, Provider Network Development

2 weeks ago

LE005 Zelis Network Solutions, LLC Convent Station, United States

Manager, Provider Network Development page is loaded · Manager, Provider Network Development · Apply · locations · US NJ Morristown · time type · Full time · posted on · Posted Yesterday · job requisition id · JR104910 · Po s · iti on O v e r · v · i ew · Responsibl ...
Staff Technologist Lab

4 days ago

Health Advocates Network-Allied Convent Station, NJ, United States

Health Advocates Network-Allied is seeking a travel Cath Lab Technologist for a travel job in Morristown, New Jersey. · Start Date: ASAP · ~ Shift: 12 hours, days · ~ Employment Type: Travel · Health Advocates Network is urgently hiring Interventional Radiology Technician in ...
Staff Technologist Lab

5 days ago

Health Advocates Network-Nursing Convent Station, NJ, United States

Health Advocates Network-Nursing is seeking a travel Cath Lab Technologist for a travel job in Morristown, New Jersey. · Shift: 12 hours, days · ~ Employment Type: Travel · ~ About Health Advocates Network-Nursing · Health Advocates Network was founded on the basis of a share ...
Business Development Director

1 week ago

Glenmede Trust Co Convent Station, United States

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. · Business Development Director · Full Time · Sales · Morristown, NJ, US · 30+ days ago · Requisition ID: 1108 · Founde ...
Head of Supply Chain

4 hours ago

Global Life Science Hub Convent Station, United States

Job Description · Job Description · Global Life Science Hub is proud to partner with a specialised Biopharmaceutical company at the forefront of next-generation drug delivery technologies and Generics drug development. · With recent FDA approvals and plans for significant growt ...
New Business Development Manager

1 week ago

Pyramid Consulting Convent Station, United States

New Business Development Manager · Morristown, NJ · Key Skills: · Prior experience in New Business Development acquiring New Clients (IT, Non-IT, Professional, Engineering). · Prior experience acquiring new business opportunities in following areas: Contract/Perm Placements, ...
Azure DevOps Engineer

2 weeks ago

Expert In Recruitment Solutions Convent Station, United States

Title: Azure DevOps Engineer · Location: Princeton, NJ · 6 months (CTH) · Must Have: Azure Certified · Role and Responsibilities: · Work with infrastructure, Architecture, and software development teams to implement CI/CD automation on-prem and in Azure cloud. · Implementat ...
Interventional Radiology Technician

2 weeks ago

New Healthcare Professionals, LLC Convent Station, United States

Job Purpose:Provides information to diagnose patient illnesses by operating radiologic equipment to produce radiographs. · Duties:* Identifies patient service requirements by establishing personal rapport with potential and actual patients and other persons in a position to unde ...
SENIOR linux admin

2 weeks ago

Motion Recruitment Partners LLC Convent Station, United States

A highly motivated Senior System Administrator is needed to join our DOD client's dynamic team in Mooristown, New Jersey. Being a pioneer in our field, they place a high importance on creativity, quality, and ongoing development. This is a fantastic opportunity in a reputable bus ...
System Medical Director, Women's Services

5 days ago

MedChi, The Maryland State Medical Society Convent Station, United States

Atlantic Health System, one of the largest non-profit healthcare networks in New Jersey, is seeking a System Medical Director of Women's Services to oversee the strategic growth of the service line across eleven counties in Northern and Central New Jersey. The Medical Director of ...
Travel MRI Technologist

1 week ago

Talent4Health Convent Station, NJ, United States

Talent4Health is seeking a travel MRI Technologist for a travel job in Morristown, New Jersey. Job Description & Requirements Specialty: MRI Technologist Discipline: Allied Health Professional Start Date: 06/03/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours, flexible Em ...
Manager, Systems Engineering

1 week ago

Penn Foster Inc Convent Station, United States

Company Description · Our Mission · At Palo Alto Networks everything starts and ends with our mission: · Being the cybersecurity partner of choice, protecting our digital way of life. · Our vision is a world where each day is safer and more secure than the one before. We are a co ...
Manager, Systems Engineering

1 week ago

Penn Foster Inc Convent Station, United States

Company Description · Our Mission · At Palo Alto Networks everything starts and ends with our mission: · Being the cybersecurity partner of choice, protecting our digital way of life. · Our vision is a world where each day is safer and more secure than the one before. We are ...
QA Analyst III

5 days ago

Money Fit by DRS Convent Station, United States

About our Business: · 21CS is an international software development company, with our U.S Centre of Excellence and Development Lab. · We develop and maintain Mainframe-based software products, partnering with leaders in the Z industry, to service our global customer network. We p ...
Systems Data Analyst

5 days ago

24x7 ESI Convent Station, United States

Job Title: · Systems Data Analyst · Educational Qualification: · Bachelors or higher degree in computer science or Information Technology · is a must. · Work address: · 412 Mount Kemble avenue, Morristown, NJ, 07960 · Write, update, and maintain computer programs or software ...
Radiology Service Engineer II

1 week ago

Atlantic Health System Convent Station, United States

Job Description · Atlantic Health System is seeking a full-time Radiology Service Engineer II for the Clinical Engineering Department at Morristown Medical Center to work 8am-4pm, including on-call. · Essential Function/Responsibilities: · Fully experienced with an extensive sk ...
QA Analyst III

5 days ago

21st Century Software Convent Station, United States

About our Business: · 21CS is an international software development company, with our U.S Centre of Excellence and Development Lab. · We develop and maintain Mainframe-based software products, partnering with leaders in the Z industry, to service our global customer network. We ...
Senior Mainframe Developer

5 days ago

21st Century Software Convent Station, United States

About our Business: · 21CS is an international software development company, with our U.S Centre of Excellence and Development Lab located in Morristown, New Jersey. · We develop and maintain Mainframe-based software products, partnering with leaders in the Z industry, to servi ...
Travel Cath Lab Technologist

1 week ago

Talent4Health Convent Station, NJ, United States

Talent4Health is seeking a travel Cath Lab Technologist for a travel job in Morristown, New Jersey. Job Description & Requirements Specialty: Cath Lab Technologist Discipline: Allied Health Professional Start Date: 05/27/2024 Duration: 13 weeks 36 hours per week Shift: 12 hours, ...
Azure Cloud Engineer

5 days ago

Crum and Forster Convent Station, United States

Azure Cloud Engineer (Morristown, NJ or Remote) · Job Locations · US-NJ-MORRISTOWN | US-NJ-Remote | US-FL-Remote | US-TX-Remote · Job ID · Category · IT · Type · Regular · Crum & Forster Company Overview · Crum & Forster (C&F) · , with a proud history dating to 1822, pr ...