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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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Your education. Our inspiration.

This is a brilliant combination. This is where people united with passion and a purpose can make a huge impact. This is Anthem, where innovation is the force that will drive the future of health care.

So what drives you? If it's the desire to build a career where your work can affect the lives of millions, you're in the right place. Take what you’ve learned to the next level, combine your knowledge with our experience, expertise and resources; and start changing peoples’ lives.

Anthem is one of Fortune magazine’s Most Admired Companies, has a wealth of opportunities for students and graduates who are ready to make a difference.

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Ready to build a career where you make a difference and impact millions of lives? Review our undergraduate and graduate internship programs where you can combine your knowledge, experience and expertise in a growing industry.

Build your career, or even start it through our undergraduate and graduate internships that help us identify future leaders. We’re transforming our industry and here’s the chance to be a part of it.

 

Anthem Strategic Consulting

What drives you? For our Anthem Internal Consulting Practice, Anthem Strategic Consulting (ASC), it's an opportunity to address Anthem’s most significant business priorities, growth objectives and long-term strategy through an internal consulting practice that integrates rigorous external business acumen coupled with insider Anthem institutional perspective and knowledge.

As one of the nation's leading health benefit companies, Anthem is transforming healthcare for millions. We are navigating the changes in the healthcare market and building on our commitment to make a lasting, positive difference for our consumers, care providers, and communities.

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Your Questions, Answered

You have to be at least 18 years of age (unless part of an approved/sponsored program) and currently enrolled in an accredited US college or university. For actuarial students, sitting for or having at least one exam completed by the time your interview is an advantage.

Visit our main page and search internships – apply via APPLY link on the specific opportunity.

We offer internships that are 3 months, 6 months and part-time during the school year. Our opportunities are based on business needs and student availability.

We are delighted to get to know you! Our team participates in various on-campus events throughout the year and from time to time hosts meetings in our offices. The fastest way to see where you stand in the application process is to log into our system to check your status.

Because internships are temporary positions, the only benefits offered at this time are access to our onsite fitness facilities, and the ability to contribute to a 401k. We do, however, offer opportunities to get connected, and be mentored through our various ARGs (Associate Resource Groups).