Provider Network Manager I/II

1 month ago

Meridian, United States Blue Cross of Idaho Health Service, Inc. Full time

Develop and maintain positive working relationships with contracted providers. Actively audit and monitor financial performance of all assigned providers to ensure network sustainability. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners. Ensure accurate implementation and administration of contracts.

We are looking for a Provider Network Manager with:

Level I: 4 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience

Level II: 6 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience

Education: Bachelor's degree or equivalent work experience (Two years' work experience is equivalent to one year of college)

What a day of a Provider Network Manager may look like:

  • Analyze, review, and project financial impacts of network arrangements.
  • Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation.
  • Ensure accurate implementation and administration of executed networks and/or programs.
  • Implement reimbursement strategies designed to control healthcare costs.
  • Use data from multiple sources to recommend innovative payment initiatives and methodologies.
  • Prepare and present financial performance reports on assigned networks to leadership.
  • Formulate, analyze, coordinate, and negotiate contracts with provider networks.
  • Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements.
  • Prepare and present to healthcare organizations, clients, and internal business partners.
  • Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs.
  • May identify provider payment or utilization variations and take action to resolve. Communicates variations to leadership.
  • Perform other duties and responsibilities as assigned.


Reasonable Accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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