Anthem, Inc. Provider Network Management Director in Newbury Park, California
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Provider Network Management Director
Preferred location is California
Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, hospitals and capitated physician groups (not just one of these provider types). Primary focus of this role is contracting and negotiating contract terms. Must have experience with capitation and hospital contracting. Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers. Familiarity with Medicaid manage care strongly preferred.
Primary duties may include, but are not limited to:
Serves in a leadership capacity, 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, but this position will not have direct reports.
Works with the most complex providers such as large hospital systems, large capitated medical groups, and providers in areas with significant competition.
Contracts involve non-standard arrangements that require a high level of negotiation skills and strong quantitative skills
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.
Requires a BA/BS degree and 8-10 years’ experience in contracting, provider relations, provider servicing; experience must include at least 4 years of contracting experience with hospitals and/or capitated physician groups
Or any combination of education and experience, which would provide an equivalent background.
Requires travel 20% statewide
Familiar with CA managed care provider market strongly preferred
Familiar with Medicaid managed care
Familiar with capitated or risk contracting
Good written and verbal communication
Quantitative skills for advanced contracting and negotiation experience required
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.