Provider Network Management Director

Elevance Health; Los Angeles (CA); Hybrid; USD 119,000 - 186,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Stock purchase plan

Wellness programs

Job summary

Elevance Health in California is seeking a senior contracts leader focused on provider network contracting for large health systems. The role combines in-office collaboration three days per week with flexible, hybrid work and requires extensive negotiation of complex terms and fee schedules.

You will lead negotiations, develop relationships with providers, prepare financial projections, and work on enterprise network initiatives across commercial, Medicaid, and Medicare lines, with a salary

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.

Responsibilities

• 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

Skills

Negotiation

Contracting

Leadership

Project management

Business development

Strategic thinking

Education

BA/BS degree

Tools

Excel

Financial modeling

PowerPoint

Job description

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

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 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.

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
• 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
• 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.

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 and Influenza. 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 [e-mail] assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act