Provider Jobs in Orange, CA

Provider Network Management Director

Location : This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Travels to worksite and other locations as necessary.

Please note that per our policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Network Management Director is responsible for developing and managing the provider network through strategic contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups, including employed, hospital-based, and hospital-owned ancillary providers. The primary focus of this role is contracting and negotiating complex terms with the most intricate health systems and affiliated providers, supporting value-based initiatives. This individual will bring comprehensive experience across all lines of business-including Medicare, Medicaid, and commercial and will have skill not only in contracting but also solid understanding of claims, pricing, and system configuration. The ideal candidate must possess contracting and negotiation experience involving $25 million or more. Additionally, they should have experience with executive presentations, possess a higher level of coordination, and be able to effectively engage with executive leadership, demonstrating seasoned executive presence.

How you will make an impact :

Serves 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.

Contracts involve non-standard arrangements that require a high level of negotiation skills.

Fee schedules are 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 providers and the company.

Conducts the most complex negotiations.

Prepares financial projections and conducts analysis.

Minimum Requirements :

Requires a BA / BS degree and a minimum of 8 years' experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience :

Experience in healthcare contracting, with direct skill in negotiating with large providers and service vendors, strongly preferred.

Proven track record of successfully negotiating and managing provider contracts, with a comprehensive understanding of industry standards, billing codes, reimbursement mechanisms, and the regulatory landscape, strongly preferred.

Deep knowledge of Medicare, Medicaid, and Commercial business practices, strongly preferred.

Proven ability to negotiate complex contracts with payers, securing favorable terms for the organization, preferred.

Experience using financial models and analysis to negotiate rates with providers strongly preferred.

Exceptional strategic thinking, decision-making, problem-solving skills, and adaptability highly preferred.

Experience interacting confidently with senior management and executive level stakeholders, as a subject matter expert and comfortable with influencing decision-making preferred.

Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred.

Proficient of Microsoft Office products Excel, Teams, Outlook, PowerPoint, and Word strongly preferred.

For candidates working in person or virtually in the below location(s), the salary

• range for this specific position is $116,380 to $182,160.

Locations : California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

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.

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 and Influenza. 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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.