Anthem, Inc. Payor Contracting Director in Costa Mesa, California
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources of one of America’s largest managed healthcare organizations.
Payor Contracting Director
Targeting West Coast locations - open to a remote arrangement pending background and experience
Responsible for leading and directing payor contract negotiations and contracting activities and serves as subject matter expert regarding payor contract language administration. Primary duties may include but are not limited to:
Review of payor proposals and coordination with internal business partners on the viability of rate proposal, rate structure, and methodology.
Negotiation of payor contract language taking into consideration internal departmental operations.
Coordination with internal stakeholders and leadership in the evaluation of payor contract performance including financial and membership growth in anticipation of renegotiations and/or value-based contracting opportunities and proposals.
Coordinates with delegation oversight on delegated activities including pre-delegation and ongoing audits to ensure full contract compliance.
Helps lead the implementation of new payor contracts, which includes management/administration, processes, and systems specific to regional, state, or companywide implementation.
Evaluates proposed amendments for compliance and/or business impact and coordinates with internal business partners to quantify impact prior to any implementation.
Works to drive the adoption and use of standardized payor contract language.
Leads contract reviews to ensure that payor contract terms and language can be implemented efficiently.
Represents the department and serves as a key contributor on enterprise initiatives, projects, and task forces.
Requires a BS/BA degree in related field; 10 + years business and professional experience in contracting, provider relations, and provider servicing; or any combination of education and experience, which would provide an equivalent background. Master’s degree preferred.
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. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.