Anthem WMC Director Regional Network Mgmt (PS4725) Eastern US in Henderson, Nevada
WMC Director Regional Network Mgmt (PS4725) Eastern US
Location: United States
Field: Provider Network Management
Requisition #: PS4725
Post Date: 6 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.
WMC Director Regional Network Mgmt (PS4725)
Work Location - Eastern part of the US, Work from home eligible.
Responsible for network development, provider reimbursement and network maintenance for a regional Health Services Area.
Primary duties may include, but are not limited to:
• Oversees the development, maintenance and reconciliation of physician risk contracts and capitated arrangement.
• Attracts, develops and manages key contracting and servicing staff.
• Develops innovative ways to maintain a cost effective network with adequate access and positive working relationships with providers.
• 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.
• May serve 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.
• Assists management in network development planning
• Provide work direction and establish priorities for field staff and 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 high level of negotiation skills.
• 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.
• Serves as a communication link between professional providers and the company.
• Prepares financial projections and conducts analysis.
• Identifies and resolves network access gaps or perceived gaps.
• Responsible for provider network in assigned geography
• Must have network GAP analysis experience.
• Must have expert/master knowledge with Microsoft Word, Powerpoint, Outlook, Excel.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Requires a 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.
• Masters preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.