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Director- Network Management (US)

  • Job Family: PND > Provider Relationship Account Mgmt
  • Type: Full time
  • Date Posted:
  • Req #: JR30144

Location:

  • MA, Boston
  • Massachusetts, Danvers
  • Massachusetts, Somerville
  • Massachusetts, Cambridge
  • Massachusetts, Andover

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Description

Responsible for all aspects of network development and management, inclusive of contacting, credentialing, reimbursement, and monitoring for Behavioral Health (BH) Services. Ensures that the Provider Network is established in a fair and equitable manner, and in accordance with the requirements of the MassHealth MBHP Contract and represents the full continuum of Behavioral Health Covered Services.

How will you make an impact: 

  • Oversees contracting and maintenance of all providers types including inpatient, diversional, crisis and outpatient BH services.
  • Oversees the development, implementation, maintenance, and reconciliation of Value Based and capitated contacting arrangements.
  • Develop innovative ways to maintain a cost-effective network with adequate access and availability.
  • Develop and maintain a culturally competent and diverse BH provider network that meets cultural and language needs of the population served. Ensure that its Provider Network management strategy includes at least the following activities: a) Monitor quality of care including effective use of evidence-based practices and timely access to treatment provided to Covered Individuals, including but not limited to the use of secret shoppers to confirm access. b) Utilize Network Provider profiling and benchmarking data to identify and manage Network Providers who fall below established benchmarks and performance standards, and to replicate practices of Network Providers who consistently exceed benchmarks and performance standards. c) Implement monitoring activities to ensure Network Provider compliance with the performance specifications for all BH Covered Service.
  • Attracts, develops, and manages key contracting and servicing staff.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

*Monday -Friday 9 am - 5:30 pm EST**

**Candidates that reside within 50 miles of 1000 Washington Street, Boston, MA OR reside in 02118 zip code are STRONGLY encouraged to apply**

Minimum Requirements:

  • Requires a BS/BA degree in business administration or related healthcare field and a minimum of 8 years healthcare operations, finance, underwriting, actuary, network development and sales experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Strongly preferred CPA or MBA degree.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.

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