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Dir Regional Network Mgmt ( Denver CO, Albuquerque NM,San Francisco, San Diego, Los Angeles, Seattle,WA or Portland OR)

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Provider Network Management
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PS19519 Requisition #

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. 


The position requires the candidate to be in either of these cities Denver,CO, Albuquerque NM,

 San Francisco,CA, San Diego,CA, Los Angeles,CA, Seattle WA or Portland OR



Responsible for network development, provider reimbursement and network maintenance for a regional Health Services Area.

Primary duties may include, but are not limited to: 

•           Oversees the development, maintenance and reconciliation of physician network, including but not limited to risk contracts and capitated arrangements.

•           Attracts, develops and manages key contracting and servicing staff.

•           Develops innovative ways to maintain a cost effective network with adequate access and positive working relationships with providers.

•           Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.

•           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.

•           May serve as lead contractor for large scale, multi-faceted negotiations.

•           Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.

•           Assists management in network development planning

•           Provide work direction and establish priorities for field staff and involved in associate development and mentoring.

•           Works with the most complex providers such as institutional providers,IPA/PHO’s, large medical groups and ancillary providers, and providers in areas with significant competition.

•           Contracts involve non-standard arrangements that require a high level of negotiation skills.

•           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.

•           Serves as a communication link between professional providers and the company. 

•           Prepares financial projections and conducts analysis.

•           Identifies and resolves network access gaps or perceived gaps.

•           Responsible for provider network in assigned geography

•           Must have network GAP analysis experience.

•           Must have expert/master knowledge with Microsoft Word, Powerpoint, Outlook, Excel.

•           Hires, trains, coaches, counsels, and evaluates performance of direct reports.


  Requires a BS/BA degree in business administration or related healthcare field; 8-10 years healthcare operations, finance, underwriting, actuary, network development and sales experience; or any combination of education and experience, which would provide an equivalent background.

•           Masters 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.

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Metrics & Data

Leverage your talents to make a difference in people's lives, by providing innovative, data-driven solutions that can measure and improve consumer's health.

Anthem metrics and data associates focus on creating innovative, data-driven solutions that can measure and track progress in our members’ health. Collaborate with internal and external experts to develop metrics-supported strategies for improving measurements and processes.

Enable physicians and hospitals to improve care with valuable information that improves care quality and affordability. Join us and help provide tools to help consumers make better decisions, as we create a simpler, more affordable, more accesible healthcare system.

Metrics and data associates at Anthem:

  • Develop statistical models and functional means for measuring the quality of health care members receive annually
  • Provide members with useful, powerful tools for self-evaluation and tracking of health issues and risk factors
  • Show initiative and make key decisions with the potential to dramatically influence patient outcomes and positively impact peoples' lives
  • Create thoughtful solutions that engage and empower members to make more informed decisions about their health and health care
  • Serve as a catalyst to improve the essential relationship between patient and health care provider
  • Leverage metrics and data to deliver resources that help overcome traditional coverage barriers such as education, literacy and language

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