Provider Network Manager (US)

Elevance Health; Los Angeles (CA); Hybrid; USD 71,000 - 116,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

Elevance Health in Los Angeles, CA is seeking a Provider Network Manager to develop and negotiate provider contracts, manage relationships, and service the network. The role focuses on California PPO networks, fee-for-service rate negotiations, contract terms, and cross-functional collaboration to resolve complex issues.

Occasional travel to work sites is required. The position supports a hybrid work model with in-office days and remote work, and emphasizes value-based contracting and provider

Qualifications

• Requires BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, or equivalent.
• Strong contract negotiation skills with focus on language and rates.
• Experience negotiating fee-for-service rates and managing provider contracts.

Responsibilities

• 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.
• Travel to worksite and other locations as necessary.

Skills

Contract negotiation

Provider relations

Relationship management

Cross-functional collaboration

Analytical skills

Education

BA/BS degree

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.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $70.812.00 to $116,334

Location(s): California, Colorado, Nevada

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 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, 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.

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 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.