Provider Network Mgr Sr (Woodland Hills or Sacramento, CA) - 61042 PI
WellPoint - Woodland Hills, CA

This job posting is no longer available on WellPoint. Find similar jobs: Provider Network Manager Senior jobs - WellPoint jobs

Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of California’s oldest and largest health insurers. At Anthem, 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.

Provider Network Manager Sr

Responsible for developing the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Focus will be on government contracting: State Sponsored business such as Medi-Cal, Healthy Families and other Government Products such as MediCare. This level typically works with more complex providers at least 50% of the time. Complex providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical 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. Fee schedules can be customized. Works with increased independence and requires increased use of judgment and discretion. Serves as resource for lower-leveled consultants. May work on cross-functional projects requiring collaboration with other key areas. Essential duties may include, but are not limited to: 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. Also responsible for managing the financial and operational performance of provider networks within a market and to support growth within assigned markets. Must understand financial drivers of provider networks and be able to identify and implement cost improvement strategies in order to improve overall cost of care and price points. Represents Network Management as subject matter expert on committees/projects as needed. Responsible for total (unit cost and utilization) per member per month costs for an assigned geography. Performs other duties as assigned.

Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of California’s oldest and largest health insurers. At Anthem, 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.

Provider Network Manager Sr

Responsible for developing the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Focus will be on government contracting: State Sponsored business such as Medi-Cal, Healthy Families and other Government Products such as MediCare. This level typically works with more complex providers at least 50% of the time. Complex providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical 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. Fee schedules can be customized. Works with increased independence and requires increased use of judgment and discretion. Serves as resource for lower-leveled consultants. May work on cross-functional projects requiring collaboration with other key areas. Essential duties may include, but are not limited to: 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. Also responsible for managing the financial and operational performance of provider networks within a market and to support growth within assigned markets. Must understand financial drivers of provider networks and be able to identify and implement cost improvement strategies in order to improve overall cost of care and price points. Represents Network Management as subject matter expert on committees/projects as needed. Responsible for total (unit cost and utilization) per member per month costs for an assigned geography. Performs other duties as assigned.

WellPoint - 20 months ago - save job - block
About this company
429 reviews
WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...