Anthem Provider Network Management Director - Western Region (Colorado Preferred) - 132214 in Fairfax, Virginia

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Western Region (Colorado preferred). Candidates are preferred to be located within commutable distance from an Anthem office.W@Hmay be considered upon the hiring manager's discretion.

This position will engage with the EMAP (Enterprise Modeler and Pricer) Project Teams to help facilitate and implement the EMAP tools across the enterprise and train staff on the new experience and/or functionality.

Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, ancillary, hospitals and physicians (not just one of these provider types). This role will have focus on contracting and reimbursement methodologies across the Enterprise. Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with complex providers and contractual builds.

Primary duties may include, but are not limited to:

  • Serves in a contracting expert, leading associate resources, special projects/initiatives, or network planning to implement new tools and processes
  • Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area or a business unit.
  • Supports implementation of large scale, multi-faceted negotiations and methodologies.
  • Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
  • Will assist project groups with new/refined contracting tool planning, documentation, testing, and training.
  • May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
  • Works with the most complex providers such as institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition.
  • Contracts involve non-standard arrangements that require a thorough understanding of reimbursement methodologies.
  • Works collaboratively and must be able to participate with and assist several teams, as well as independently.
  • May 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.
  • Support implementation of new tools and enhancements.

  • Requires a BA/BS degree; 8-10 years’ experience in contracting, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

  • Healthcare experience highly required
  • Ability to work in a fast-paced, changing environment.
  • Experience working in a matrixed organization highly preferred.
  • 25% travel (both local and national) required.
  • Agile experience preferred
  • EOE.M/F/Disability/Veteran /Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran./

Job Provider Network Management

Title: Provider Network Management Director - Western Region (Colorado Preferred) - 132214

Location: virginia-Fairfax

Requisition ID: 132214