Provider Network Management Director

Provider Network Management Director

Location: Woodland Hills CA, Costa Mesa CA, Walnut Creek, CA

Hours: Standard working hours

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Position Overview

Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups including employed and hospital based and hospital owned ancillary providers. Primary focus of this role is contracting and negotiating contract terms. Deals with only the most complex health systems, affiliated providers and drives and support value base initiatives.

How You Will Make an Impact

• Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning
• Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit
• Typically serves as lead contractor for large scale, multi-faceted negotiations
• Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact
• May assist management in network development planning
• May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring
• Contracts involve non-standard arrangements that require a high level of negotiation skills
• Fee schedules are customized
• 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 providers and the company
• Conducts the most complex negotiations
• Prepares financial projections and conducts analysis

Required Qualifications

• Requires a BA/BS degree and a minimum of 8 years' experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications

• Experience supporting hospital systems preferred
• Experience using financial models and analysis to negotiate rates with providers strongly preferred
• Extensive experience providing enterprise-wide support across all lines of business: Commercial, Medicaid, and Medicare strongly preferred
• High-impact provider negotiation experience is strongly preferred
• Fee Schedule customization preferred
• Claims background nice to have
• Travels to worksite and other locations as necessary

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $118,588 to $185,616

Location: 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, paid time off, stock, 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.