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Provider Network Mgr Sr - Remote in Texas (Preferably in Houston) - PS26419Location: Houston, Texas, United StatesNewRequisition #: PS26419Your 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 Mgr. Sr. – Remote in anywhere of TX (Preferably in Houston)Develop and provide oversight over the provider network through contract negotiations, relationship development, and servicing for Medicare Advantage and Medicare Medicaid Plan products. Primary focus of this role is managing State and Federal contractual requirements specific network and reporting requirements. Other key activities include; submitting reports timely, accurately, developing cost of care opportunities, and developing presentations and reporting results to various Anthem committees and regulatory leaders. Typically works with the most complex providers. Complex providers may include, but are not limited to institutional providers, large medical groups and ancillary providers, providers in areas with strong competition or where greater provider education around managed care concepts is required. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are often customized. Primary duties may include, but are not limited to: Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development of collaterals. May serve as lead over a contracting team engaged in less complex negotiations. 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. Ongoing collaboration with sales team in developing small network of providers focused upon meeting member diversity needs. Serves as a communication link between l providers and matrix partners within the company. Conducts more complex negotiations and drafts documents. May prepare financial projections and conduct analysis. Requires a BA/BS degree; 6-10 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. Requires 20%30% travel within the state of Texas including some occasional overnight travel. Project management experience preferred. Certified Black Belt or Project Management (PMI Certified) preferred. Contracting experience preferred. Proficiency in Microsoft Excel, PowerPoint or SAS coding experience preferred.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 antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran .
