Provider Network Manager Senior

Provider Network Manager Senior

Hybrid 1:
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.

Carelon Behavioral Health is a part of Elevance Health, leveraging experience, expertise, dedication, and compassion to address healthcare challenges.

The Provider Network Manager Senior develops the provider network through contract negotiations, relationship development, and servicing.

• Primary focus of this role is contracting and negotiating contract terms.
• Typically works with the most complex providers.
• Complex providers may include large institutional providers, large medical groups, ancillary providers, value-based concepts, and providers in highly competitive markets.
• Contracts involve non-standard arrangements that require advanced negotiation skills.
• Fee schedules are customized.
• Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.
• Works independently and requires high level of judgment and discretion.
• Might 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 professional providers and the company.
• Ensure that network composition includes an appropriate distribution of provider specialties.
• Conducts more complex negotiations and drafts documents.
• Prepare financial projections and conduct analysis.

• BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, or provider servicing; prior contracting experience preferred. Equivalent combinations of education and experience also acceptable.

• Experience in fee schedule development using actuarial models strongly preferred.

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, 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 elevancehealthj for 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.