🌎
This job posting isn't available in all website languages

Provider Network Mgt Director

📁
Provider Network Management
📅
PS15681 Requisition #

What Is CareMore?

CareMore is entering a new growth phase, as a proven care delivery model for the highest-risk.  We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.  We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in multiple states across Medicare, Medicaid, and commercial populations.  We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience.  As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

 

CareMore’s Health Networks, Primary Care+, Touch and CareMore@Home models drive strategy, operations, and care delivery in our national markets (Arizona, California, Colorado, Connecticut, Iowa, Nevada, New York, Tennessee, Texas, Virginia and the District of Columbia), where CareMore builds and runs capitated primary care medical groups, at-risk health networks and upstream care delivery products in service of high-risk Medicaid, Medicare and commercial patients, and our collaboration with Emory Health System in Georgia. Our comprehensive, upstream approach to health is led by robust multidisciplinary teams of extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers and community health workers), and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, led by a team of passionate, execution-minded leaders dedicated to this mission.

Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, ancillary, hospitals and physicians (not just one of these provider types). Primary focus of this role is contracting and negotiating contract terms. Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers. 
Primary duties may include, but are not limited to: 
  • 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. 
  • Typically serves 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.
  • May assist management in network development planning. 
  • May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring. 
  • Works with the most complex providers such as institutional providers, 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. 
  • Fee schedules are typically customized. 
  • 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 the most complex negotiations. 
  • Prepares financial projections and conducts analysis. 

Requirements:
 BA/BS degree; 8-10 years experience in contracting, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. 
Requires travel.

AnEqualOpportunityEmployer/Disability/Veteran

Previous Job Searches

Activity Feed

27773
Job shares through Anthem, Inc.
Someone applied to the Nurse Case Mgr I - Model of Care - PS17611 position. Less than a minute ago
Someone applied to the Strategic Sourcing Analyst-Indianapolis, IN (PS18011) position. Less than a minute ago
Someone applied to the Pharmacist Clinical (Medicare Appeals) Remote - US - PS16637 position. About a minute ago
Someone applied to the Customer Care Representative I/II- Richmond, VA- PS17474 position. About a minute ago
Someone applied to the Claims Representative I (Health & Dental)- Roanoke VA PS16506 position. About a minute ago

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 the work you affects 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.

Find An Internship

Student Programs

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.

 

MBA Program

What drives you? For MBA candidates our leadership development program is an opportunity to apply your academic and professional experience in pursuit of a rewarding and challenging career with one of Fortune magazine’s most admired companies.

Anthem is transforming healthcare for millions as one of the nation’s leading health benefit companies. We are working to not just navigate the changes in the health care market but lead. By leading we can build on our commitment to make a lasting, positive difference for our consumers, care providers, and communities.

Learn More

 

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).