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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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Supplier Registration Process

Anthem, Inc.'s supplier registration process will automatically enter your information into our prospective supplier database.

Anthem does not do business with persons or entities identified on the General Services Administration's List of Parties Excluded from Federal Programs and the HHS\OIG List of Excluded Individuals\Entities.

Anthem, Inc. Purchase Order Terms

Anthem's standard payment terms are net 50. Payment terms will be calculated from the invoice date, which should also reflect the date goods or services were received.

Anthem also offers various discount options that provide you with the opportunity for early payment and we are also encouraging our suppliers to participate in our electronic funds transfer (EFT) method of payment. The EFT method of payment will improve the efficiency of our payment processes and ensure that you are paid properly and on time.

Anthem, Inc. Supplier Registration Process

*Please Note: To complete the supplier registration process, you will leave antheminc.com and will be directed to the Ariba Network (AN) site. Once there please click on Register as New Supplier to complete the online registration form and follow the on-screen instructions.

Supplier Registration

Anthem, Inc. utilizes the Ariba Network to determine qualified suppliers that meet Anthem’s business need. Prospective suppliers should complete Ariba’s Supplier Registration Process.*

*Please Note: To complete the supplier registration process, you will leave antheminc.com and enter the Ariba Network (AN) site. Once there, please click on 'Register as New Supplier' on the left-hand side of the screen, complete the online registration form and follow the on-screen instructions.

Anthem does not do business with persons or entities identified on the General Services Administration's List of Parties Excluded from Federal Programs and the HHS\OIG List of Excluded Individuals\Entities.

What to expect next after registration

Anthem Inc.'s Procurement department will review your registration and additional materials. If our sourcing needs align with your goods or services, an Anthem Buyer will contact you to discuss next steps and other pertinent details. If there is no current need, your information will remain in our prospective supplier database for one year for processing against future requests.

Supporting Documents

Guidelines for Prospective Suppliers (PDF)

Company Policy and Procedures (PDF)

To obtain a copy of Anthem's Supplier Travel Guidelines, please send an email to TravelPoint@anthem.com.