Anthem Provider Network Manager I (CareMore) - Los Angeles, CA in Lynnwood, Washington
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination. It’s the foundation upon which we’re creating greater 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.
CareMore Health Systems was founded by physicians 25 years ago. Over time, the company has evolved into a delivery system and health plan focused on innovating on the way our patients interact with the healthcare system. Today, CareMore operates in eight states and delivers care to over 100,000 patients through both the Medicare Advantage and Medicaid programs. The company is widely regarded as being on the leading edge of care delivery innovation .
To learn more about CareMore as an organization, you should read the following articles:
- Des Moines Register – New Model: Insurers Hire Doctors
The Atlantic – The Quiet Healthcare Revolution
The Provider Network Manager serves as CareMore’s face to our contracted physician partners and works directly with the GM of the market to improve provider performance and grow CareMore’s footprint. In this role, you would develop CareMore’s provider network through contract negotiations, relationship management, financial performance analysis and servicing of provider needs. This is a fairly independent role, operating with general supervision, expected to elevate unusual situations to management as required. In addition to day-to-day responsibilities, you would also be asked to participate in strategic, intradepartmental special projects as required.
Primary duties may include, but are not limited to:
Effectively analyzes and negotiates contract rates and language within CareMore’s established benchmarks, while taking into consideration region specifics and the input of the Regional Performance Management Director, General Manager and clinical team. In addition, with the input of Legal, Terms & Conditions and Claims, drafts contracts and other documents to support agreed upon terms.
- Monitors the overall network performance for assigned region; develops and implements performance improvement plans for utilization and cost outliers on an on-going basis.
- Analyzes the network and addresses network development needs proactively, including the recruitment of new or re-contracting of existing PCPs and specialists. Works in conjunction with Regional Medical Director to identify and resolve deficiencies in specialty network.
- Trains and orients in a timely manner all newly contracted PCPs, medical groups/ IPAs and specialists, and their respective staff, on the following items: CareMore care model; member benefits; operational processes and policies; and Provider Portal, Patient Quick View and other systems. Provides additional training and educational materials as needed during first quarter of contract and over time.
- Provides accurate and timely resolution of higher-level inquiries and issues presented by PCPs, specialists, medical groups/IPAs and administrative staff that cannot be finalized by Provider Relations Coordinators. In addition, meets Provider Service goals as established by Regional Performance Management’s management team.
- Conducts quarterly JOC meetings and interim meetings, on an as-needed basis, with medical groups/IPAs and identified providers for the purpose of reviewing and improving operational and financial results via influencing physicians’ behaviors.
- Delivers PCP Report Cards timely; trains providers on performance criteria and how to improve performance to maximize bonus potential. Interim meetings conducted to ensure PCPs are engaged (as measured by ranking system) and performing at or above established regional benchmarks.
- Responsible for promoting to the PCPs within the assigned region the use of CareMore’s care centers and clinical programs and compliance with HEDIS and other programs/metrics, as they relate to CareMore initiatives such as CMS Star Rating and HCC coding.
- Coordinates efforts with Sales Team to ensure regional membership goals are achieved.
- Participates on cross-functional projects requiring collaboration with key internal departments.
Monitors contract loading and administration to ensure all systems accurately reflect contract language, rates and intent.
Requires a BA/BS degree; two (2) years of experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.
/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 Diversity Inc 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. /
Job Provider Network Management
Title: Provider Network Manager I (CareMore) - Los Angeles, CA
Other Locations: CA-Los Angeles
Requisition ID: 130269