Provider Network

1 week ago

South Portland, United States Elevance Health Full time

Provider Network Contracting Manager Sr. (JR127689)

Location: Must reside in New Hampshire or outlying states AND requires residence within 50 miles and 1 hour commute to our Manchester, NH office.

Hybrid Work Strategy : This role requires Monday and Tuesdays in the Manchester office at a minimum. There will be up to 15% travel within the state of New Hampshire.

The Provider Network Manager Sr . develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with the most complex providers. Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, 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 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.

  • 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 sales team in making presentations to employer groups.

  • 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:

  • 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 Qualifications:

  • 3 years contract negotiation experience, preferably within health plan/managed care environment.

  • Knowledge of Value-Based agreement components a plus.

  • Experience in fee schedule development using actuarial models strongly preferred.

  • Travel throughout the state of New Hampshire 10 – 15% expected.

  • Project management skills.

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