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Provider Network Manager I - California - PS27407

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Provider Network Management
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PS27407 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.


Provider Network Manager I 


This position is responsible for developing and expanding on relationships with Anthem Blue Cross physician, physician groups, IPAs/Primary Medical Groups (PMGs), Contracted facilities, hospital and ancillary networks and managing the functions relating to provider servicing, operations, provider education, and network development within Southern California. 

 

Primary duties may include, but are not limited to:

 

- Project Management of local and statewide tasks associated with Network Relations, such as tracking and trending of processes, monitoring complex and resource intensive projects, and delivery of updates to both to Leadership and Network Relations staff.

- Analysis and evaluation of current provider, specialty and ancillary networks.  Identify gaps and deficiencies, and provide results with opportunities.

- Supports Network Relations staff with urgent and pressing disputes coming from the Anthem network.  Involvement in claims, member, and clinical related research and engagement for escalation.

- Responsible for the monitoring of Quality of Service to our network clients, surveying the Anthem provider network based on Delegated models with PMGs, and operational distinctions between the Health Plan and a PMG.

- Assist in development of advocacy and education processes and communications with providers, PMGs, hospitals and ancillary networks. Including informational bulletins, power point presentations, and other materials required for external or internal communications.

- In conjunction with leadership, assist in the development of strategies for growth and branding throughout the provider network.

- Develops and implements a tracking processes that ensure providers, PMGs, hospitals and ancillary provider complaints and issues are mitigated in a reasonable time period.

- Engagement and support escalated issues coming from State and Local oversight agencies.

- Requires a BA/BS in Business Administration, Healthcare Administration, or a related field; and 5-7 years of experience in a managed healthcare or hospital environment, 3+ years of experience in provider/network relations; 1-3 years of leadership/ management experience; or any combination of education and experience, which would provide an equivalent background.

- Experience developing relationships with physicians/providers is required

- Requires previous management experience

- Experience with network relations, provider contracting, provider servicing and education is required

- Knowledge of State Medi-Cal Program.

- Knowledge of network contracting models in California.

- Knowledge of different reimbursement methodologies based on Medicaid and CMS guidelines is required.

- Must have excellent communication skills (written and verbal) and interpersonal skills

- Requires strong PC skills (Word, Excel, etc.)

- Requires strong organizational and project management skills

- Valid driver's license and access to a motor vehicle required.


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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