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Anthem Sr. Provider Network Manager (Medicare) Ohio or Kentucky in Dayton, Ohio

Sr. Provider Network Manager (Medicare) Ohio or Kentucky

Location: Ohio, United States


Field: Provider Network Management

Requisition #: PS15432

Post Date: 3 days ago

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.

Develops and oversees the Medicare Advantage value based provider network through contract negotiations, relationship development, and servicing. The primary focus is overseeing the Medicare Advantage value based contract performance across several markets to drive success. Typically works with the most complex providers at least 50% of the time. Complex providers may include, but are not limited to institutional providers, large medical groups and providers in areas with strong competition or where greater provider education around value based population health concepts is required. Contracts involve value based gain share and risk arrangements that require a high level of negotiation skills. Primary duties may include, but are not limited to:

  • Serves as key resource and subject matter expert for local market 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 to help grow membership.

  • Oversees and may conduct more complex negotiations.

  • Reviews financial projections and conduct analysis

  • Must possess above average communication skills

  • Requires a BA/BS degree; 5-7 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.

  • Requires travel

  • Medicare knowledge of STARs, RAF, HCCs, etc.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran