Provider Network Manager (US)

Elevance Health; Costa Mesa (CA); Hybride; USD 110 000 - 160 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

401(k) + match

Stock purchase plan

Wellness programs

Résumé du poste

Elevance Health in California seeks a Provider Network Manager to develop and manage the provider network through contract negotiations, relationship development, and servicing. The role focuses on contracting terms, rate negotiations, and network needs across California PPO providers.

Ideal candidates will have a BA/BS and at least 3 years in contracting or provider servicing, with the ability to negotiate complex terms. Hybrid work and travel are involved as needed.

Qualifications

• BA/BS degree and minimum 3 years of contracting experience.
• Experience in provider networks and PPO provider terms.
• Strong negotiation and relationship management skills.

Responsabilités

• Develop the provider network through contract negotiations, relationship development, and servicing.
• Maintain a primary focus on contracting and negotiating contract terms.
• Manage California PPO provider territories, including fee-for-service rate negotiations and strategy.
• Lead resolution of complex provider contracting and reimbursement issues with cross-functional teams.
• Negotiate contracts with non-standard arrangements requiring moderate negotiation skills.
• Travel to worksite and other locations as necessary.

Connaissances

Provider contracting

Contract negotiations

Provider relations

Rate negotiations

Formation

BA/BS degree

Description du poste

Anticipated End Date:

2026-10-27

Position Title:

Provider Network Manager (US)

Job Description:

Provider Network Manager

Location: This role requires associates to be in-office 1 - 2 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. Alternate locations may be considered if candidates reside within a commuting distance from an office

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.

The Provider Network Manager will be responsible for developing the provider network through contract negotiations (language and rates), relationship development, and servicing.

How you will make an impact:

• Develop the provider network through contract negotiations (language and rates), relationship development, and servicing.
• Maintain a primary focus on contracting and negotiating contract terms.
• Manage assigned California PPO provider territories, including fee-for-service rate negotiations, provider contracting strategy, relationship management, and ongoing network needs.
• Lead resolution of complex provider contracting and reimbursement issues in partnership with cross-functional teams, including rate and contract discrepancies, provider escalations, implementation issues, and remediation efforts impacting PPO providers
• Work with less-complex to complex providers.
• Support contracting for providers that may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, ancillary providers, and providers in areas with increased competition or where greater provider education around managed care concepts is required.
• Negotiate contracts that may involve non-standard arrangements requiring a moderate level of negotiation skills.
• Apply value-based concepts understanding.
• Customize fee schedules as needed.
• Work with increased independence and exercise judgment and discretion.
• Participate in cross-functional projects requiring collaboration with other key areas.
• Serve as a communication link between professional providers and the company.
• Conduct more complex negotiations and draft documents.
• Assist in preparing financial projections and conducting analysis as required.
• Travel to worksite and other locations as necessary.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

PND > Network Contracting

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, and 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 and 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.