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Provider Network Mgt. Director

Company: CareMore Health
Location: San Bernardino
Posted on: August 9, 2019

Job Description:

What Is CareMore?CareMore is entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in multiple states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America's largest managed healthcare organizations.CareMore's Health Networks, Primary Care+, Touch and CareMore@Home models drive strategy, operations, and care delivery in our national markets (Arizona, California, Colorado, Connecticut, Iowa, Nevada, New York, Tennessee, Texas, Virginia and the District of Columbia), where CareMore builds and runs capitated primary care medical groups, at-risk health networks and upstream care delivery products in service of high-risk Medicaid, Medicare and commercial patients, and our collaboration with Emory Health System in Georgia. Our comprehensive, upstream approach to health is led by robust multidisciplinary teams of extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers and community health workers), and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, led by a team of passionate, execution-minded leaders dedicated to this mission.Develops the provider network through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, ancillary, hospitals and physicians (not just one of these provider types). Primary focus of this role is contracting and negotiating contract terms. Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers.Working territory of San Bernardino County AreaPrimary Duties May Include, But Are Not Limited ToServes in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.Typically serves as lead contractor for large scale, multi-faceted negotiations.Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.May assist management in network development planning.May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.Works with the most complex providers such as institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills.Fee schedules are typically customized.Working with the most complex providers such as institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills.Fee schedules are typically customized.Works independently and requires high level of judgment and discretion.May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.May collaborate with sales team in making presentations to employer groups.Serves as a communication link between professional providers and the company.Conducts the most complex negotiations. Prepares financial projections and conducts analysis.Requirements: BA/BS degree; 8-10 years experience in contracting, provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. 5+ years of Healthcare Provider Mgt Analytics, Reporting and Dissecting Data.Requires travel. 75%Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.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 healthcare.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.

Keywords: CareMore Health, San Bernardino , Provider Network Mgt. Director, Executive , San Bernardino, California

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