Network Management Consultant Senior
8a - 5p | Mon - Fri
100% Remote - with the possibility to go into the office a few times a month, as well as travel to provider sites when COVID restrictions are lifted
Build the possibilities. Make an extraordinary impact:
- Serves as a technical resource, trainer and mentor to other consultants and contracting staff members. Provides provider relations and/or network management consulting support to complex, and/or large high profile provider organizations.
How you will make an impact (including but are not limited to):
- Provides guidance regarding resolution of issues that require the intervention of the Provider Engagement and Contracting Department.
- Identifies and facilitates process improvement projects to improve network provider's experience, to reduce provider abrasion and to reduce costs.
- Serves on inter-departmental committees and project teams to assist with root cause analysis of provider issues, and communicates positive outcomes/solutions to provider issues/concerns.
- Develops and maintains policies and procedures and provides training to team members.
- Acts as department lead in manager's absence.
- Develops and maintains positive relationships with the provider community by conducting routine and issue-based on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues.
- Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices.
- Assists with network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers.
- Participates in large and/or complex network expansion efforts to recruit new physician specialties or large physician groups, hospitals, and health systems
- Develops the provider network through contract negotiations (language and rates), relationship development, and servicing.
- Value-based concepts understanding - awareness of PMPM payment, full risk contracting, and quality and cost incentives
- Involvement relative to CoC (cost of care) initiatives
- Requires a BA/BS degree in business, health administration or related field and a minimum of 5 years experience in provider network management, utilization management or related health care field; or any combination of education and experience, which would provide an equivalent background.
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 firstname.lastname@example.org for assistance.