Provider Network Manager (US)

Provider Network Manager Location: This role requires associates to be in-office 1 - 2 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 if candidates reside within a commuting distance from an office 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 Manager will be responsible for developing the provider network through contract negotiations (language and rates), relationship development, and servicing. How You Will Make An Impact Develop the provider network through contract negotiations (language and rates), relationship development, and servicing.Maintain a primary focus on contracting and negotiating contract terms.Manage assigned California PPO provider territories, including fee-for-service rate negotiations, provider contracting strategy, relationship management, and ongoing network needs.Lead resolution of complex provider contracting and reimbursement issues in partnership with cross-functional teams, including rate and contract discrepancies, provider escalations, implementation issues, and remediation efforts impacting PPO providersWork with less-complex to complex providers.Support contracting for providers that 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, and providers in areas with increased competition or where greater provider education around managed care concepts is required.Negotiate contracts that may involve non-standard arrangements requiring a moderate level of negotiation skills.Apply value-based concepts understanding.Customize fee schedules as needed.Work with increased independence and exercise judgment and discretion.Participate in cross-functional projects requiring collaboration with other key areas.Serve as a communication link between professional providers and the company.Conduct more complex negotiations and draft documents.Assist in preparing financial projections and conducting analysis as required.Travel to worksite and other locations as necessary. 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.