Provider Network Manager (US)

The Elevance Health Companies, Inc.; Los Angeles (CA); Hybrid; USD 110,000 - 160,000; Full time

Job summary

Elevance Health is seeking a Provider Network Manager to lead contracting and relationship development across California PPO providers, negotiating fee-for-service rates and terms to strengthen the network. You will collaborate with cross-functional teams, manage complex negotiations, and support provider education, while traveling to work sites as needed in a hybrid work environment.

A BA/BS and 3+ years in contracting or provider relations are required; strong communication and analytical

Qualifications

• BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, or related field.

Responsibilities

• Lead provider network contracting and relationship development for California PPO providers.
• Negotiate fee-for-service rates and contract terms to strengthen the network.
• Collaborate with cross-functional teams to resolve complex contracting and reimbursement issues.
• Travel to worksite and other locations as necessary for negotiations and meetings.

Job description

Provider Network Manager (US)

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.

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 note 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.

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.

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.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.