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　　Provider Network Manager Sr.

　　Job Family: Digital and Technology

　　Type: Full time

　　Date Posted:Jan 23, 2024

　　Anticipated End Date:Feb 06, 2024

　　Reference: JR102735

　　Location:

　　CA, COSTA MESA

　　CA, WOODLAND HILLS

　　CA, WALNUT CREEK

　　CA, PALO ALTO

　　Description

　　Location: we are targeting our California office locations for this position which includes Woodland Hills, Palo Alto, Walnut Creek, and Costa Mesa.

　　* _this position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 times per week. The rest of the time would be working remotely (from home). The ideal candidate will live within 50 miles of one of our Elevance Health office locations.*_

　　The Provider Network Manager Sr. will develop the provider network through contract negotiations, relationship development, and servicing for all Commercial and Government lines of business. Primary focus of this role is contracting and negotiating contract terms for Medicaid/MediCAL, in addition to acting as point guard as initial assessor for new programs, benefits, or any projects impacting the business unit requirement. Typically works with the most complex providers that involve non-standard arrangement and may require customized fee schedule with high level of negotiation skills, required to analyze financial reports, and have strong communication skillset. Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, fee-for-service, value-based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required. Must have strong critical, creative, and innovative thinking. Additionally, must possess analytical and detailed skills, and can work independently to troubleshoot assignments that are not spelled out.

　　How you will make an impact:

　　Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.

　　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 our Medicaid Plan partners, Clinical UM partners, and any other internal business partners as needed.

　　Serves as a communication link between professional providers and the company.

　　Ensure that network composition includes an appropriate distribution of provider specialties.

　　Conducts more complex negotiations and drafts documents.

　　Prepare financial projections and conduct analysis.

　　​

　　Minimum requirements:

　　Requires a BA/BS degree and a minimum of 5 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.

　　Preferred skills, capabilities, and experiences:

　　Experience in fee schedule development using actuarial models strongly preferred. Travels to worksite and other locations as necessary.

　　For candidates working in person or remotely in the below locations, the salary* range for this specific position is $98,900 to $129,000.

　　Locations: California

　　In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

　　The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

　　Who We Are

　　Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

　　How We Work

　　At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

　　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.

　　Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

　　The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

　　Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

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　　Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

　　EEO Policy Statement

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　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])