Description

Provider Network Mgmt Dir

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint

location in MA. Local travel expectations as needed.

UniCare is a proud member of Elevance Health’s family of brands, offering Medicaid plans to residents of West Virginia, as well as commercial and Medicare plans to members insured through the Commonwealth of Massachusetts Group Insurance Commission (GIC).

Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups including employed and hospital based and hospital owned ancillary providers. Primary focus of this role is contracting and negotiating contract terms. Deals with only the most complex health systems, affiliated providers and drives and support value base initiatives

How you will make an impact:

Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.
Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.
Typically serves as lead contractor for large scale, multi-faceted negotiations.
Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
May assist management in network development planning.
May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
Contracts involve non-standard arrangements that require a high level of negotiation skills.
Fee schedules are customized.
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 providers and the company.
Conducts the most complex negotiations.
Prepares financial projections and conducts analysis.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 8 years’ experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

Experience using financial models and analysis to negotiate rates with providers strongly preferred.
Contracting experience highly preferred.
Previous experience leading design and execution of Value Based Payment Models highly preferred.
Experience and knowledge in healthcare industry is strongly preferred.
Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties.
Experience interacting confidently with senior management, as s subject matter expert and comfortable with influencing decision-making.
Mastery of Microsoft Office products, most notably Excel, PowerPoint, Teams, Outlook, and Word strongly preferred.

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. A Fortune 20 company with a longstanding history in the healthcare industry, 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.

Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 – 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 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. 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.