Provider Network Management Director
Elevance Health

Job Info

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Provider Network Management Director

Location: This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of our Nashville, TN office.

The Provider Network Management Director develops the provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups including employed and hospital based and hospital owned ancillary providers. Primary focus of this role is contracting and negotiating contract terms. Deals with only the most complex health systems, affiliated providers and drives and support value base initiatives.

How you will make an impact:

• Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.
• 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 for a business unit.
• Typically serves as lead contractor for large scale, multi-faceted negotiations.
• Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
• May assist management in network development planning.
• May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
• Contracts involve non-standard arrangements that require a high level of negotiation skills.
• Fee schedules are customized.
• Works independently and requires high level of judgment and discretion.
• 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.
• Serves as a communication link between providers and the company.
• Conducts the most complex negotiations.
• Prepares financial projections and conducts analysis.

Minimum Qualifications:

• Requires a BA/BS degree and a minimum of 8 years' experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Experience using financial models and analysis to negotiate rates with providers strongly preferred.
• Provider network build with demonstrated success in implementing recruiting plans and network adequacy experience strongly preferred.
• Commercial line of business contracting experience along with Tennessee provider landscape knowledge strongly preferred.
• Travels to worksite and other locations as necessary.

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