Provider Network Executive IV

Overview

Workforce Classification: Hybrid

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Senior Provider Network Executive (PNE IV) develops and maintains effective relationships with Premera’s most strategic and complex provider accounts to achieve operational and strategic goals, product development strategies, and continuity of Premera’s vision and values. In this highly visible role, the PNE IV is responsible for the negotiation and management of Premera’s most complex and critical provider relationships across the state of Washington.

Success in this position supports Premera’s strategy and the implementation of new products through engagement and negotiation with providers to facilitate their support and acceptance of the various strategies and products Premera implements.

• Develop and execute ongoing account management and service strategies to meet corporate strategic / financial objectives.
• Lead negotiation and implementation of complex, multifaceted provider contracts.
• Complete negotiations within preplanned targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts.
• Serve as the main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
• Build and maintain positive relationships, generally with the most complex and significant provider/systems. Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment.
• Develop and maintain effective multifaceted and strategic provider networks, with complex payment methodologies and alternate funding arrangements. Participate in payment and delivery systems innovation initiatives.
• Monitor and analyze financial and quality metrics to assess effectiveness of networks, report findings to leadership, and create action plans.
• Develop strong understanding of providers’ business drivers and performance.
• Collaborate with Healthcare Economics in rate development and proposal analysis.
• Lead a high-level, cross-functional team to provide operationally excellent service and support to strategic accounts.
• Consult and educate assigned account and internal leadership, providing industry and cross-market expertise. Create provider specific and public presentations.
• Provide input and/or drive development of payment methodologies and provider engagement strategies.
• Advise Provider Strategy & Solutions leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
• Engage providers to promote the concept and understanding of patient engagement adherence, cost savings programs.
• Other duties and projects as assigned.

• Bachelor’s degree or four (4) years of experience in a provider or payer environment. (Required)
• Six (6) years of experience in payer or provider contracting and managing provider relationships in the health care or insurance industry to include:
  Four (4) years of experience negotiating…