Anthem Provider Network Mgr I/II/Sr - Nashville, TN (Office-based) - PS5429 in Memphis, Tennessee

Provider Network Mgr I/II/Sr - Nashville, TN (Office-based) - PS5429

Location: United States

Field: Provider Network Management

Requisition #: PS5429

Post Date: May 11, 2018

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

This position will directly interface with external providers for training and network development of the Long Term Services & Supports (LTSS) network (CHOICES, ECF CHOICES) developing training programs and supporting network development. The individual in this position will manage and maintain policies and procedures, provider facing collateral materials as well as strategy development and execution for service expansion with existing and potential providers.

Primary duties include, but are not limited to:

Provider Network Manager I

Develops the provider network through targeted recruitment, relationship development, and servicing. Primary focus of this role is training (internal and external) and network development. Typically works with LTSS providers which may include, but are not limited to, Nursing Faciities, CHOICES HCBS providers and ECF CHOICES providers. May participate in intradepartmental projects or smaller projects impacting multiple departments. Operates with general supervision, elevating unusual situations to management as required.

Primary duties may include, but are not limited to:

  • Develops and deploys the annual Network Development Training Plan for management, PR & LTSS leadership.

  • Develops and maintains all LTSS provider facing collateral materials as well as LTSS PR owned policies and procedures.

  • Designs and develops training programs for both internal stakeholders as well as external provider partners.

  • Conducts quarterly LTSS PR departmental training needs assessment and identifies skills or knowledge gaps to be addressed.

  • Serves as a communication link between LTSS (CHOICES, ECF CHOICES) providers and the company.

  • Conducts initial and ongoing training of LTSS providers.

  • Assists in strategy development for service expansion and recruitment with existing and potential provider.

  • Assists with leveraging existing network to solve for Service Initiation Delays.

  • Collaborates with internal stakeholders (contracting, support coordination, care coordination, HCM etc.) to identify and solve for network adequacy deficiencies for targeted recruitment outreach activities.

  • Participates in regional recruitment activities (contracting, support coordination, care coordination) and conducts recontracting efforts as needed.

Provider Network Manager II

Responsible for developing the provider network through targeted recruitment, relationship development, and servicing. Primary focus of this role is training (internal and external) and network development. This level typically works with more complex LTSS providers at least 50% of the time. Complex providers may include, but are not limited to, Nursing Facilities, CHOICES HCBS providers and ECF CHOICES providers with statewide service coverage areas.. Recruitment and expansion activities may require a moderate level of negotiation skills.. Works with increased independence and requires increased use of judgment and discretion. Serves as resource for lower-level consultants. May work on cross-functional projects requiring collaboration with other key areas.

Essential duties may include, but are not limited to:

  • Develops and deploys the annual Network Development Training Plan for management, PR & LTSS leadership. - Develops and maintains all LTSS provider facing collateral materials as well as LTSS PR owned policies and procedures.

  • Designs and develops training programs for both internal stakeholders as well as external provider partners. - Conducts quarterly LTSS PR departmental training needs assessment and identify skills or knowledge gaps to be addressed.

  • Serves as a communication link between LTSS (CHOICES, ECF CHOICES) providers and the company.

  • Conducts more complex recruitment and network development activities.

  • Assists in preparing State Reports and conducting analysis as required.

  • Assists with leveraging existing network to solve for Service Initiation Delays.

  • Collaborates with internal stakeholders (contracting, support coordination, care coordination, HCM etc.) to identify and solve for network adequacy deficiencies for targeted recruitment outreach activities.

  • Participates in regional recruitment activities (contracting, support coordination, care coordination) and conducts recontracting efforts as needed.

  • Performs other duties as assigned.

Provider Network Manager Sr.

Responsible for developing the provider network through targeted recruitment, relationship development, and servicing. Primary focus of this role is training (internal and external) and network development. This level typically works with the most complex LTSS providers at least 50% of the time. Complex providers may include, but are not limited to Nursing Facility providers, CHOICES HCBS providers and ECF CHOICES providers with statewide service coverage areas. Recruitment and expansion activities involve nonstandard arrangements that require a high level of negotiation skills. Serves as key resource for other LTSS provider relations staff and provides mentoring and on-the-job training and development. May serve as lead over a network development team engaged in less complex negotiations. Works independently and requires high level of judgment and discretion. May work on cross-functional projects requiring collaboration with other key areas or serve on enterprise projects around network management as needed.

Essential duties may include, but are not limited to:

  • Develops and deploys the annual Network Development Training Plan for management, PR & LTSS leadership. - Develops and maintains all LTSS provider facing collateral materials as well as LTSS PR owned policies and procedures.

  • Designs and develops training programs for both internal stakeholders as well as external provider partners. - Conducts quarterly LTSS PR departmental training needs assessment and identify skills or knowledge gaps to be addressed.

  • Serves as a communication link between LTSS (CHOICES, ECF CHOICES) providers and the company.

  • Conducts more complex recruitment and network development .

  • Assists in preparing State Reports and conducting analysis as required.

  • Assists with leveraging existing network to solve for Service Initiation Delays.

  • Collaborates with internal stakeholders (contracting, support coordination, care coordination, HCM etc.) to identify and solve for network adequacy deficiencies for targeted recruitment outreach activities.

  • Participates in regional recruitment activities (contracting, support coordination, care coordination) and conducts recontracting efforts as needed.

  • Performs other duties as assigned.

*Please note: position level will be determined upon candidates' skills, experience and education.*

Provider Network Manager I

  • Requires a BA/BS degree; 2 years experience in contracting, provider relations, provider servicing or any combination of education and experience that would afford equivalent competencies.

  • Must have strong oral and written communication skills, good analytical skills, and PC skills.

  • Advanced organizational skills with the ability to handle multiple assignments.

  • Skilled Nursing, CHOICES, ECF CHOICES experience required.

  • Long Term Care experience required.

  • 3+ years of health care/managed care experience.

Preferred

  • 1+ years experience with Medicare and Medicaid regulations strongly desired.

  • Experience in market and network analysis preferred.

  • Experience developing training curriculum and network development strategies preferred. - Intermediate level of proficiency in claims processing and issue resolution.

  • Proven work experience as a Training Coordinator, Trainer, Training Facilitator or similar role.

  • Proven ability to complete full training cycle (assess needs, plan, develop, coordinate, monitor and evaluate).

Provider Network Manager II

  • Requires BA/BS, Masters degree preferred, and 3-5 years experience in contracting, provider relations, provider servicing or any combination of education and experience that would afford equivalent competencies.

  • Must have strong oral and written communication skills, good analytical skills, and PC skills.

  • Advanced organizational skills with the ability to handle multiple assignments.

  • Skilled Nursing, CHOICES, ECF CHOICES experience required.

  • Long Term Care experience required.

  • 3+ years of health care/managed care experience required.

Preferred

  • 1+ years experience with Medicare and Medicaid regulations strongly desired.

  • Experience in market and network analysis preferred.

  • Experience developing training curriculum and network development strategies preferred. - Intermediate level of proficiency in claims processing and issue resolution.

  • Proven work experience as a Training Coordinator, Trainer, Training Facilitator or similar role.

  • Proven ability to complete full training cycle (assess needs, plan, develop, coordinate, monitor and evaluate).

Provider Network Mgr Sr.

  • Requires BA/BS and 5-7 years experience in contracting, provider relations with an emphasis on Medicaid operations, provider servicing or any combination of education and experience that would afford equivalent competencies.

  • Must have strong oral and written communication skills, good analytical skills, and PC skills.

  • Advanced organizational skills with the ability to handle multiple assignments.

  • Skilled Nursing, CHOICES, ECF CHOICES experience required.

  • Long Term Care experience required.

  • 3+ years of health care/managed care experience required.

  • Must demonstrate leadership skills.

Preferred

  • 1+ years experience with Medicare and Medicaid regulations strongly desired. Experience in market and network analysis preferred.

  • Experience developing training curriculum and network development strategies preferred. Intermediate level of proficiency in claims processing and issue resolution.

  • Proven work experience as a Training Coordinator, Trainer, Training Facilitator or similar role.

  • Proven ability to complete full training cycle (assess needs, plan, develop, coordinate, monitor and evaluate).

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 antheminc.com/careers. EOE. M/F/Disability/Veteran.