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Provider Networks Director in San Francisco, CA at Anthem, Inc.

Date Posted: 6/23/2018

Job Snapshot

Job Description

Provider Networks Director-Northern, CA:
Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies,    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. 
This position may work from home or one of Anthem’s offices, but the candidate must be located within CA within drive of a local office.
Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and/or capitated IPAs.  Primary focus of this role is contracting and negotiating contract terms. Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers. Primary duties may include, but are not limited to: 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. Typically serves 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. 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 the most complex providers such as institutional providers, large medical groups, 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. Conducts the most complex negotiations. Prepares financial projections and conducts analysis.
 Additional duties may include but are not limited to:
- Delivers competitive cost of care trends in assigned state.
  • Develops provider networks that provide a competitive advantage.
  • Aligns contracting strategy with medical management strategy.
  • Integrates quality metrics and incentives into contracting process.
  • Serves as Provider Solutions local single point of accountability for Medicare and/or Medicaid product lines.
  • Facilitates implementation of new risk/capitation agreements.
  • Ensures compliance with regulatory and accreditation standards.
  • Collaborates with other areas to develop contacting approaches that are supportive of membership growth.

Requires a BA/BS degree; 8-10 years’ experience in contracting, provider relations, provider servicing; experience must  include prior hospital and capitated medical group contracting experience; or any combination of education and experience, which  would provide an equivalent background. Requires travel.
Familiarity with CA hospital and IPA market, and Medicare and/or Medicaid products strongly preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.