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RVP Medicare Network Management (134467) in New York, NY at Anthem, Inc.

Date Posted: 4/15/2018

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.

Leads the entire network management function within an assigned geographical location. Oversees the total relationship with all providers including physicians, hospitals, and care centers in that location.

Primary duties may include, but are not limited to:
  • Develops and implements network contracting and network expansion strategies specific to local markets in the assigned regions, to include identifying and cultivating strategic alliances and building new network models with significant provider organizations. Provides strategic design and implementation of high performance networks to include facility and provider performance incentives.

  • Delivers planned medical trends and high quality/large provider networks that support business objectives for MLR, growth and income results.

  • Requires collaborating and working with sales team to identify customers’ needs and to close network gaps.

  • Assists staff, as needed, during contract negotiations with high-volume provider groups or facilities.

  • Chairs and/or participates on internal committees, joint operating committees with provider organizations (providers) and operations meeting.

  • Ensures compliance with all regulatory and accreditation standards. Oversees provider services to include provider education and general provider relations support.

  • Oversees and directs efforts across a shared service platform/matrix organization related to provider network performance to achieve regional goals related to quality, financial, and growth objectives.

  • Must exhibit a strong competency and understanding of provider collaboration models that optimize market performance and sustainability. 

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Job Requirements

Requires a BA/BS degree; 10 years progressively responsible related experience in contract negotiation, network development and provider relations; or any combination of education and experience, which would provide an equivalent background.

 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