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Provider Network Manager

  • Job Family: Digital and Technology
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR101007

Location:

  • CA, CERRITOS
  • California, San Francisco
  • California, San Diego
  • California, Los Angeles
  • California, Sacramento
  • California, Oakland
  • California, Alameda
  • California, San Jose
  • California

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Description

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Carelon Behavioral Health, Inc. will be the Third Party Administrator for California’s Statewide School-Based Fee Schedule project. Key responsibilities will include claims payment and remittance, network management, provider credentialing, data exchange and reporting and quality oversight. As part of this exciting opportunity, we are working on growing our team!

As part of Governor Newsom’s Master Plan for Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI), the Department of Health Care Services (DHCS) is expanding access to school-based (or school-linked) behavioral health services provided to students at a school site.

Specifically, DHCS, in collaboration with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), is establishing a statewide, multi-payer, school-linked fee schedule (CYBHI fee schedule) to reimburse school-linked providers for the provision of specified outpatient mental health and substance use disorder (SUD) services furnished to students 25 years of age or younger at a school site.

*Seeking candidates that reside in either: Northern California, Bay Area, Central Coast or Southern California.*

This position is a hybrid role and the person in this position must live within 50 miles of a California Elevance Health location. Work Schedule: Monday - Friday, 8:00 am - 5:00 pm PST

The Provider Network Manager develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with the most complex providers. Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required.  Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are customized.

Primary duties may include, but are not limited to:

  • Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.
  • 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.
  • Ensure that network composition includes an appropriate distribution of provider specialties. 
  • Conducts more complex negotiations and drafts documents.
  • Prepare financial projections and conduct analysis.

Minimum Requirements:

  • Requires a BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.
  • Experience in fee schedule development using actuarial models strongly preferred. Travels to worksite and other locations as necessary.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $64,000 to $115,200

Locations:  California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. 

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
 


 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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