Anthem Provider Network Manager II (Nationwide) #129958 in Sacramento, California
/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.
_Location: Nationwide (This is a Work From Home Opportunity)_
_Provider Network Manager II (Nationwide)_ #129958
Develops the provider network through contract negotiations, oversight, relationship development, and servicing. Primary focus of this role is contracting and negotiating complex contract terms. Complex providers include, but are not limited to, complex national sub-delegates which include but not limited to non-emergency transportation, vision, and dental vendors, and ancillary providers with more complex contracts. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are typically customized. Works with increased independence and requires increased use of judgment, discretion and ability to problem solve.
Primary duties may include, but are not limited to: * Serves as resource for lower-leveled consultants. * Responsible for oversight of national sub-delegates. * Serves as a communication link between sub-delegates and the company. * Conducts complex negotiations and drafts documents. * Assists with cost of care activities. * Works closely with legal, actuarial and Health Plan teams to ensure contractual terms meet Anthem, state and federal requirements and are within budget. * Assists in preparing financial projections and conducting analysis as required. * Responsible for ensuring compliance with all regulatory, CMS, NCQA, state and Federal regulations. * Candidate must be a critical thinker and have the ability to solve problems. * Performs other duties as assigned.
- Requires a BA/BS degree, minimum 5 years of experience in contracting, rate negotiation, customized contract development, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.
- May require travel. /Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./
Job Provider Network Management
Title: Provider Network Manager II (Nationwide) #129958
Requisition ID: 129958