Anthem Inc. Actuarial Jobs

Job Information

Anthem, Inc. Provider Network Manager or Provider Network Manager Senior in Harrisonburg, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Provider Network Manager or Provider Network Manager Senior

Please Note: This position may be filled at either the Provider Network Manager or Provider Network Manager Senior level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Preferred Location: Roanoke, VA area

Will consider other locations for the most qualified applicant

Provider Network Manager

The Provider Network Manager will develop the provider network through contract negotiations (language and rates), relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms in multiple lines of business, including Commercial, Medicare, and Medicaid. Typically works with less-complex to complex providers. Providers 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, providers in areas with increased competition or where greater provider education around managed care concepts is required. Contracts may involve non-standard arrangements that require a moderate level of negotiation skills. Value based concepts understanding. Fee schedules can be customized.

Primary duties may include, but are not limited to:

  • Works with increased independence and requires increased use of judgment and discretion.

  • May work on cross-functional projects requiring collaboration with other key areas.

  • Serves as a communication link between professional providers and the company.

  • Conducts more complex negotiations and drafts documents.

  • Assists in preparing financial projections and conducting analysis as required.

Provider Network Manager Senior

The Provider Network Manager Senior will develop the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms in multiple lines of business, including Commercial, Medicare, and Medicaid. Typically works with the most complex providers. Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are customized.

Primary duties may include, but are not limited to:

  • 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.

  • 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 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.

Qualifications

Provider Network Manager – 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.

Provider Network Manager – Preferred Qualifications:

  • Experience with Commercial, Medicare, and Medicaid contracting preferred.

  • Value-Based contracting experience highly desired.

  • May require travel up to 30%.

Provider Network Manager Senior – Minimum Requirements:

  • Requires a BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Provider Network Manager Senior – Preferred Qualifications:

  • Experience with Commercial, Medicare, and Medicaid contracting preferred.

  • Value-Based contracting experience highly desired.

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

  • May require travel up to 30%.

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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For® , is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS62949-Virginia

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