SHIFT: Day Job
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 at one of America’s leading health care companies and a Fortune Top 50 Company.
Director – Network Management (Contracting)
Responsible for network development and provider reimbursement for the Statewide Health Services Area. Primary duties may include, but are not limited to: Oversees contracting and maintenance of all facilities including hospitals, surgery centers, etc. Oversees the development, maintenance and reconciliation of physician risk contracts and capitated arrangements. Attracts, develops and manages key contracting staff. Develops innovative strategies to maintain a cost effective network with adequate access and positive working relationships with providers. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- BS/BA degree in business administration or related healthcare field
- 8-10 years’ healthcare operations, finance, underwriting, actuary, network development and sales experience; or any combination of education and experience, which would provide an equivalent background.
- CPA or MBA
- Comprehensive knowledge and understanding of managed care principles and practices, experience in fee for service, value based payment models, hospital, complex health systems, physician and ancillary provider types
- Demonstrated track record of success in negotiating with providers including preparation and design of the negotiation as well as execution
- Proven ability to prepare and present managed care strategies
- Demonstrated analytical skills, including financial modeling and reimbursement technologies
- Knowledge of payer and hospital/physician managed care operations
- Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid