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Provider Network Mgr I - Remote in Highlands, Hardee and Manatee Counties, FL - PS27091Location: Florida, United StatesNewRequisition #: PS27091Your Talent. Our Vision . At Simply Healthcare , a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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.Location: Highlands, Hardee and Manatee Counties, FL - MUST be able to travel daily within these territoriesProvider Network Mgr IDevelops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. In this role you would work with less complex providers which may include, but are not limited to, professional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts. Contracts tend to be more standard and afford less opportunity for customization. Fee schedules are fairly standardized with reimbursement models limited and well-defined. May participate in intradepartmental projects or smaller projects impacting multiple departments. Operates with general supervision, elevating unusual situations to management as required. Primary duties may include, but are not limited to: Solicits participation in the network and conducts re-contracting efforts as needed. Serves as a communication link between professional providers and the company. Conducts limited negotiations and drafts documents. Assists in preparing financial projections as required. Requires a BA/BS degree; 2 years’ experience in provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. 2 years’ experience in basic & value based contracting required. Requires travel 80%90% of the time. Medicare experience preferred. Medicaid experience preferred. At least 1 year experience in contract negotiation required. Proficient in MS Excel and Word preferred. Bilingual (Spanish/English) preferred. Excellent verbal and written communication skill required.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc 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.
