Provider Network Manager at Elevance Health in Waukesha, Wisconsin

Job Description:

Location: N17W24222 Riverwood Dr., Ste 300 Waukesha, WI



Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the minimum in-office commitment being 1-3 days in an office per week.


Candidates must reside within 50 miles or 1-hour commute each way of the above Elevance Health location.



Develops the provider network through contract negotiations (language and rates), relationship development, and servicing.



PRIMARY DUTIES:

• Primary focus of this role is contracting and negotiating contract terms.


• Typically works with less-complex to complex providers.


• Providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required.


• Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.


• Value based concepts understanding.


• Fee schedules can be customized.


• Works with increased independence and requires increased use of judgment and discretion.


• May work on cross-functional projects requiring collaboration with other key areas.


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


• Assists in preparing financial projections and conducting analysis as required.

Minimum Requirements:



Requires a BA/BS degree and a minimum of 3 years' experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.



Preferred Skills, Capabilities and Experience:

• Excellent Microsoft, Excel, and PowerPoint skills.


• Great communication and organization skills.


• Ability to speak with providers and office staff.


• Preferred knowledge of claims, health insurance industry payment methods.


• Travels to worksite and other locations, as necessary.

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