Provider Network Mgt Director (Georgia) - 61280 PI
WellPoint - Georgia

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Blue Cross Blue Shield of Georgia is a proud member of the WellPoint family of companies. At BCBS of Georgia, we are dedicated to improving the lives of the people we serve and the health of our communities.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Payment Innovation Overview

WellPoint’s Payment Innovation team is focused on reforming our current healthcare delivery system. Despite having the most costly health system in the world, the U.S. health care system ranks last or next-to-last on five dimensions of a high performing health system. As stewards of our customer’s healthcare dollar, Anthem’s goal is to drive improvements in the system that changes this picture through arrangements with our providers that:

  • rationalize the connection between price, cost and value with a focus on quality and the total cost of care
  • move away from the current, unsustainable, model that rewards volume over value.
  • create the right incentives to foster – and enable – hospitals, health system, physicians and other providers make the right decisions based on community need and evidence based standards of quality and appropriate care.
Anthem is committed to migrating from volume to value based provider payment arrangements. This commitment is evidenced by our large and successful portfolio of payment innovation arrangements, including hospital and physician Pay for Performance programs, Bundle Payment arrangements, Accountable Care models, Patient Centered Medical Homes, and Chronic Care Models. This position plays a critical role in supporting one or more of these payment innovation arrangements.

Provider Network Mgmt Director

Develops the provider network for Anthem’s Patient Centered Primary Care program through contract negotiations, relationship development, and servicing for targeted primary care physicians and practices. Primary focus of this role is local management of the Patient Centered Primary Care program. Spends 100% of the time either in a leadership role or that of subject matter expert and manages the Patient Centered Primary Care program providers. Contracts involve non-standard arrangements that require a high level of negotiation skills and financial acumen including but not limited to shared savings/shared risk models such as ACOs, Patient Centered Medical Homes, and bundle payments .Primary duties may include, but are not limited to: Serves in a leadership capacity, leading associate resources, special projects/initiatives, and network planning & strategy around the Patient Centered Primary Care program. Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit. Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact. May assist management in network development planning. May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring. Works with providers participating in the patient centered primary care program including complex providers. Contracts involve non-standard arrangements that require a high level of negotiation skills and financial acumen. Fee schedules are typically customized. 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. Prepares financial projections and conducts analysis.

Job Qualifications

Requires a BA/BS degree; 8-10 years experience in contracting, project management, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. Experience with payment innovation programs strongly preferred. Completes other duties as assigned. Requires travel.

WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at EOE

Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).

  • Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.

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We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more...