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Provider Network Management Director - Payment Innovation - Pewaukee, WI (Office-based) - PS2628 in Pewaukee, WI at Anthem, Inc.

Date Posted: 3/14/2018

Job Snapshot

Job Description

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.
Payment Innovation Overview
Anthem's Payment Innovation team is focused on reforming our current healthcare delivery system.  Despite having the most costly health system in the world, the U.S. health care system ranks last or next-to-last on five dimensions of a high performing health system.  As stewards of our customer's healthcare dollar, Anthem's goal is to drive improvements in the system that changes this picture through arrangements with our providers that:
  • rationalize the connection between price, cost and value with a focus on quality and the total cost of care
  • move away from the current, unsustainable, model that rewards volume over value
  • create the right incentives to foster - and enable - hospitals, health system, physicians and other providers to make the right decisions based on community need and evidence based standards of quality and appropriate care.
Anthem is committed to migrating from volume to value based provider payment arrangements.  This commitment is evidenced by our large and successful portfolio of payment innovation arrangements, including hospital and physician Pay for Performance programs, Bundle Payment arrangements, Accountable Care models, Patient Centered Medical Homes, and Chronic Care Models.  This position plays a critical role in supporting one or more of these payment innovation arrangements.
Title: Provider Network Management Director of Payment Innovation
Location: Pewaukee, WI (Office-based)
The Network Director for Payment Innovation Programs is responsible for the strategy and implementation of Payment Innovation and Provider Collaboration Programs. The Network Director is the point of contact for provider organizations to address overall contracting, performance, and operational elements for the Program.
Develops the provider network for Anthem’s payment innovation programs through contract negotiations, relationship development, and servicing for targeted provider organizations. Primary focus of this role is local management of Enhanced Personal Healthcare, bundled payments, and other payment innovation programs. Spends 100% of the time either in a leadership role or that of subject matter expert related to Payment Innovation Programs. Contracts involve non-standard arrangements that require a high level of negotiation skills and financial acumen including but not limited to shared savings/shared risk models such as ACOs, Patient Centered Medical Homes, and bundle payments.
Primary duties may include, but are not limited to:
  • Serves in a leadership capacity, leading associate resources, special projects/initiatives, and network planning & strategy around the Patient Centered Primary Care program.
  • 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.
  • Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
  • May assist management in network development planning.
  • May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.
  • Works with providers participating in the patient centered primary care program including complex providers.
  • Contracts involve non-standard arrangements that require a high level of negotiation skills and financial acumen.
  • Fee schedules are typically customized. 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.
  • Prepares financial projections and conducts analysis.


Job Requirements

  • Requires a BA/BS degree; 8-10 years experience in contracting, project management/six sigma, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. Graduate degree preferred.  Experience with payment innovation programs strongly preferred. Completes other duties as assigned.
  • Requires travel primarily within local market to meet with providers, approximately 25%.
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 EOE. M/F/Disability/Veteran.