Director Network Management (Contracting)
Posted on: 18 Jan 2021
Nashville, TN
Job Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.
Director Network Management (Contracting)
Responsible for network development and provider reimbursement for the Statewide Health Services Area. Primary duties may include, but are not limited to: Oversees contracting and maintenance of all facilities including hospitals, surgery centers, etc. Oversees the development, maintenance and reconciliation of physician risk contracts and capitated arrangements. Attracts, develops and manages key contracting staff. Develops innovative strategies to maintain a cost effective network with adequate access and positive working relationships with providers. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
* BS/BA degree in business administration or related healthcare field
* 8-10 years healthcare operations, finance, underwriting, actuary, network development and sales experience; or any combination of education and experience, which would provide an equivalent background.
Preferences:
* CPA or MBA
* Comprehensive knowledge and understanding of managed care principles and practices, experience in fee for service, value based payment models, hospital, complex health systems, physician and ancillary provider types
* Demonstrated track record of success in negotiating with providers including preparation and design of the negotiation as well as execution
* Proven ability to prepare and present managed care strategies
* Demonstrated analytical skills, including financial modeling and reimbursement technologies
* Knowledge of payer and hospital/physician managed care operations
* Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid
Anthem, Inc.
Indianapolis, IN
Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial & Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small group, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products.
The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services.
Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2018, it served 40 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
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IndustryHealthcare
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No. of Employees63,900
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Website
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Jobs Posted1634
