Anthem Inc. Medical Jobs

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Anthem, Inc. Director Network Management - Government Programs (Contracting) in Atlanta, Georgia

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Director Network Management - Georgia

Responsible for network development, management and provider reimbursement for providers assigned by type and/or territory in the Georgia Market. Primary duties may include, but are not limited to:

  • Oversees complex contract negotiations and maintenance for fee for service and value-based reimbursements with facilities and professional providers.

  • Builds relationships that foster growth and expansion of broader value-based business opportunities to support the local market strategy.

  • Collaborates with matrix partners including but not limited to, Claims, Operations, Medical Management. Credentialing, Legal, Healthcare Economics, Compliance, Sales and Marketing and Service.

  • Meets unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.

  • Understands and utilizes tools to analyze, review trend and to develop strategies to create best outcome for financial impact of larger or complex provider contracts and alternate contract terms.

  • Assists and/or escalates provider complaints for education and/or resolution.

  • Responsible for overseeing accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.

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

  • Develops innovative ways to maintain a cost effective network with adequate access and positive working relationships with providers.

Qualifications

  • 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

  • CPA or MBA preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS42516

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