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Elevance Health Network Management Consultant Sr. in Costa Mesa, California

Network Management Consultant Sr. + Location: California, California + Job Family: PND > Provider Experience + Type: Full time + Date Posted:Jun 22, 2022 + Req #: PS75008 Description Build the possibilities. Make an extraordinary impact: Serves as technical resource, trainer and mentor to other consultants and contracting staff members. Provides provider relations and/or network management consulting support to complex, and/or large high profile provider organizations. How you will make an impact: + Responsible for coordinating the process for most complex pricing arrangements involving facilities or large health systems, or high-profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed. + Prepares and maintains contracts and documentation with multiple payment methodologies for hospitals and other certain ancillary providers. Complies and analyzes data in support of contract development. + Analyzes and prepares contracts with multiple complex payment methodologies (per diem, per case, stop loss, OHAS fee schedule, rapid treat, charge caps, etc.) as defined by DRGs, revenue codes, cpt codes, etc. Constructs pricing exhibits, utilizing multiple payment methodologies, covering multiple contract periods. + Provides guidance regarding resolution of issues that require the intervention of the Provider Solutions and Contracting Department. + Identifies and facilitates process improvement projects to improve network provider's experience, to reduce provider abrasion and to reduce costs. + Serves on inter-departmental committees and project teams to assist with root cause analysis of provider issues, and communicates positive outcomes/solutions to provider issues/concerns. + Develops and maintains policies and procedures and provides training to team members. + Acts as department lead in manager's absence. + Develops and maintains positive relationships with the provider community by conducting routine and issue-based on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues. + Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices. + Conducts seminars to support the understanding of managed care and BCBS policies and procedures. + Assists with network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers. + Participates in large and/or complex network expansion efforts to recruit new physician specialties or large physician groups. Minimum Requirements: + Requires a BA/BS degree in business, health administration or related field and a minimum of 5 years experience in provider network management, utilization management or related health care field; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: + Experience working directly with contracting directors and managers to understand what is negotiated is highly preferred. + Experience with ensuring how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading is highly preferred. + Experience with ensuring contracts comply with state and federal laws is highly preferred. + Strong critical thinking skills, a proven eye for detail and a focus on quality is highly desirable. Applicable to Colorado Applicants Only: Annual Salary Range*: $73,040 - $91,300 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. * The hourly or salary range is the range Elevance Health Inc. in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Be part of an Extraordinary Team Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at 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 contactability@icareerhelp.comfor assistance. EEO is the LawEqual Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. + EEO Policy Statement + EEO is the Law Postero + EEO Poster Supplement-English Version + Pay Transparency + Privacy Notice for California Residents Elevance Health, Inc. is an E-verify Employer Need Assistance?Email us ( or call 1-877-204-7664