Anthem Provider Network Mgr I - Marion County, FL (South Region) - PS1444 in Tampa, Florida

Provider Network Mgr I - Marion County, FL (South Region) - PS1444

Location: Florida, United States

Field: Provider Network Management

Requisition #: PS1444

Post Date: May 11, 2018

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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Provider Network Manager I - Marion County, FL (South Region) - PS1444

MUST be able to travel daily within the territory listed. Will be managing accounts in South region. This requires some travel between Marion, Putnam, Levy, Citrus, Sumter, Lake, Hernando (Specialty) and surrounding areas.

The selected candidate must reside within the territory area.

The Provider Network Manager develops the provider network through contract negotiations, relationship development, and servicing. The primary focus of this role is contracting and negotiating contract terms. In this role you would work with less complex providers which may include, but are not limited to, professional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts. These contracts tend to be more standard and afford less opportunity for customization and the fee schedules are fairly standardized with reimbursement models limited and well-defined. You may participate in intradepartmental projects or smaller projects impacting multiple departments. You would operates with general supervision, elevating unusual situations to management as required.

Primary duties may include, but are not limited to:

  • Solicits participation in the network and conducts re-contracting efforts as needed.

  • Serves as a communication link between professional providers and the company.

  • Conducts limited negotiations and drafts documents.

  • Assists in preparing financial projections as required.

  • BA/BS degree preferred;

  • 2 years experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.

  • Requires travel 90% of the time; must have reliable transportation.

  • Medicare experience required.

  • Medicaid experience 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 EOE. M/F/Disability/Veteran.