Provider Network Manager or Sr - PS37957

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.We have an opening for Provider Network Manager job family to serve on our Centralized Statewide Contracting Team. Due to the current COVID-19 (coronavirus) pandemic, you can work remotely from your home for now. Ideally, the candidate would be able to work in Nashville, TN office down the road but we are also open to remote opportunities for best-fit candidate with frequent travel aligned to your remote location in TN. This position may be filled as a Provider Network Manager or Senior. The level will be determined in accordance to the incumbent’s education, experience, and skill-set in relationship to the position. Provider Network Manager Develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with less complex providers to complex providers which may include, but are not limited to, professional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts. Contracts may involve non-standard arrangements that require a moderate level of negotiation skills. Fee schedules are fairly standardized with reimbursement models limited and well-defined. May participate in intradepartmental projects or smaller projects impacting multiple departments. Operates with general supervision, elevating unusual situations to management as required. Primary duties may include, but are not limited to: Solicits participation in the network and conducts re-contracting efforts as needed. Serves as a communication link between professional providers and the company. Conducts more complex negotiations and drafts documents. Assists in preparing financial projections as required. Provider Network Manager Sr. Develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with the most complex providers at least 50% of the time. Complex providers may include, but are not limited to institutional providers, large medical groups and ancillary providers, providers in areas with strong competition or where greater provider education around managed care concepts is required. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are often customized. Works independently and requires high level of judgment and discretion.Primary duties may include, but are not limited to: Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development. May serve as lead over a contracting team engaged in less complex negotiations. 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. Conducts more complex negotiations and drafts documents. May prepare financial projections and conduct analysis. Qualifications Provider Network Manager Requires a BA/BS degree; 35 years’ experience in contracting negotiation, provider servicing; or any combination of education and experience, which would provide an equivalent background. Requires about 75% travel down the road. Virtual engagement during pandemic is available. Seasoned network development professional who is strong in negotiating and maintaining contract preferred.Provider Network Manager Sr. Requires a BA/BS degree; 5-7 years’ experience in contracting negotiation, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. Requires about 75% travel down the road. Virtual engagement during pandemic is available. Seasoned network development professional who is strong in negotiating and maintaining contract preferred.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS37957-US