Job Details

Provider Network Manager I – West Region – CA, WA, OR, CO, NM, TX, NV, and AZ – 128774


Provider Network Management

Statewide
California, Arizona, Nevada, New Mexico, Washington, Texas, Colorado

May 19, 2017

Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.

Provider Network Manager I – West Region – CA, WA, OR, CO, NM, TX, NV, and AZ – 128774


**The selected candidate must reside within the territory. No relocation assistance will be provided.

This Provider Network Manager position supports the Medicare West Region and is responsible for developing and enhancing the Medicare provider network through contract negotiations, relationship development, and servicing.

Primary duties may include, but are not limited to:

* Provides support and acts as the primary liaison with key provider groups that participate in Anthem’s Medicare Advantage value based, provider collaboration arrangements, referred to as the Enhanced Personal Health Care Program.

* Collaborates with various internal departments to effectively implement and manage provider collaboration risk arrangements.

* Serves as a subject matter expert in Medicare for the Anthem plan and collaborates with the provider contractors and provider relations representatives to meet provider service needs.

* Participates in strategy development of the Medicare network and market expansion initiatives.

* Oversees provider education activities related to Anthem’s Medicare products, including development of presentations for orientations and education.

* May collaborate with the various internal teams such as Payment Innovations, Sales, Quality and Provider Relations in making presentations to key provider groups.

* Recommends and drafts provider communications relative to health plan policies and procedures for Anthem’s Medicare products.

* Coordinates processes pertaining to contract implementation and maintenance.

* May work on cross-functional projects requiring collaboration with other key areas.

* May perform special projects.

* Develops and enhances the participating Medicare Advantage network by contracting primary and specialty care providers within assigned territory.

* Supports the Sales team in developing/enhancing provider relationships that encourages marketing opportunities.

Qualifications

* Requires a BA/BS degree;

* 2 years experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.

* Experience must have been from the health care/managed care industry.

* Experience in developing provider networks through contract negotiations, relationship development and servicing is required, as well as resolving complex provider issues.

* Experience with Medicare contracting and/or reimbursement methodologies is preferred.

* Proficiency in MS Excel and PowerPoint is preferred.

* Will require travel in the assigned territory at least 50% of the time with little to no overnight stay. Travel could be anywhere within the assigned territory to include metro as well as rural areas.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

*WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application.