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Medicare Provider Network Manager II (Miami-Dade, Florida Area) - 139719 in Miami, FL at Anthem, Inc.

Date Posted: 2/12/2018

Job Snapshot

Job Description

Your Talent.  Our Vision.  At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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. 

Provider Network Manager II (Medicare)


Location:  Miami-Dade FL Office Location 

Develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with more complex providers at least 50% of the time. Complex providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, 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. Fee schedules can be customized. Works with increased independence and requires increased use of judgment and discretion. Primary duties may include, but are not limited to:

  • Serves as resource for lower-leveled consultants.
  • May work on cross-functional projects requiring collaboration with other key areas.
  • May collaborate with sales team in making presentations to employer groups.
  • 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.

 

Job Requirements

  • Requires a BA/BS degree; 3-5 years experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. Requires travel within assigned territory.  Medicare provider network management experience strongly preferred. 

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 antheminc.com/careers. EOE. M/F/Disability/Veteran.