Provider Network Manager I - California - PS27407
- 📁
- Provider Network Management
- 📅
- PS27407 Requisition #
- 📅
- Sep 27, 2019 Post Date
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.
