Network Management Consult at Elevance Health in Rocky Hill, Connecticut

Job Description:

The Network Management Consult provides provider relations/network management consulting support to complex, high profile provider organizations. Serves as technical resource and mentor to other consultants.



Location: This is a hybrid position and will require 1-2 days per week in the Rocky Hill, CT office.



How you will make an impact:

• Develops network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers.
  
  


• Conducts negotiations and leads contracting efforts with complex, high profile provider organizations to build and maintain a cost effective, accessible provider network.
  
  


• Identifies, researches and analyzes economic and professional provider practice patterns to develop recommendations for improvements.
  
  


• Consults with, educates and trains providers on innovative alternative reimbursement programs. Conducts seminars to support the understanding of managed care and BCBS policies and procedures.
  
  


• Participates in network expansion efforts to recruit new physician specialties or large physician groups.
  
  


• Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices.
  
  

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 3 years experience in provider network management, utilization management or other health care field; or any combination of education and experience, which would provide an equivalent background.
  
  

Preferred Skills, Capabilities, and Experiences:

• Demonstrate ability to analyze PAR data from the Tableau platform, existing and other PAR processes, supporting healthcare systems, and identifying provider performance improvement opportunities strongly preferred.
  
  


• Excellent oral, written and interpersonal communication skills, strong analytical, organizational, planning, problem solving, and project/decision facilitation skills strongly preferred.
  
  


• Masters Degree preferred, licensure recommended.
  
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Apply Now