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Senior Manager, Provider Network Development

3 months ago

Morristown, United States Zelis Full time
Position Overview:

As part of the Price Optimization division, this role is responsible for the overall strategy and development of Zelis contracted network providers (current and prospective) in an effort to increase the savings achieved for Zelis clients for existing and new products. Cultivate organization's' overall direct contracted PPO assets to support multiple products and achieve corporate objectives for PPO product viability.

What you will do:

• Negotiates complex contracts and coaches contracting team for network development efficiency.

• Executes corporate contracting strategy for multiple product lines (primary, supplemental, government, and workers compensation).

• Serves as a resource for all providers in a variety of markets; large and key strategic groups, health systems, and national arrangements.

• Compiles, maintains, and analyzes provider and hospital fee schedules to identify cost savings opportunities.

• Develops and communicates network development goals including target acquisitions, claim dollars captured, and revenue achieved.

• Provides continuous feedback and updates to organization's direct contract strategy.

• Creates and manages tools necessary to capture provider targets, measure performance and provide feedback and recommendations to executive team.

• Recruits, coaches and mentors Network Development staff. Initiates and effectively communicates a variety of human capital related actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.

• Must be available to travel up to 25% of the time.

• Performs other duties as required.

What you will bring:

• Bachelor's degree with +12 years of experience; Master's +8 yrs. or overall equivalent experience.

• Direct people management of a complex team of individuals; Hires, promotes, drives pay adjustments, assess performance and other people decisions, coaches, mentors, role models of company values, role models diversity, inclusion and wellness.

• Advanced understanding of contract language and can explain according to audience.

• In-Depth level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

• In-Depth knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs.

• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.

• Demonstrated leadership and motivation skills, a self-starter with an ability to research and resolve issues.

Work environment:

• A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.

• A standard business environment exists with moderate noise levels.

• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.

• Ability to sit for extended periods of time.

Location and Workplace Flexibility: We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.