PROVIDER NETWORK MANAGER jobs in West Virginia

PROVIDER NETWORK MANAGER manages the operations of a healthcare provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a PROVIDER NETWORK MANAGER recruits, hires, trains, and measures performance of staff to provide effective and operations within budget. May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, PROVIDER NETWORK MANAGER requires a bachelor's degree. Typically reports to top management. The PROVIDER NETWORK MANAGER typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a PROVIDER NETWORK MANAGER typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Provider Network Manager Sr
  • Elevance Health
  • WV, WV FULL_TIME
  • Description

    Develops the provider network through contract negotiations, relationship development, and servicing.

    Primary focus of this role is contracting and negotiating contract terms. Typically works with the most complex providers. Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are customized.

    How will you make an impact: 

    • Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.
    • 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 professional providers and the company.
    • Ensure that network composition includes an appropriate distribution of provider specialties.
    • Conducts more complex negotiations and drafts documents.
    • Prepare financial projections and conduct analysis.

    Minimum Requirements:

    • Requires a BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.
    • Experience in fee schedule development using actuarial models strongly preferred.
    • May require travel up to 30%.

     

    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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

    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. 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.comfor assistance.

  • 1 Month Ago

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Advanced Practice Provider – Nurse Practitioner / Physician Assistant
  • Transformations Care Network
  • Morgantown, WV FULL_TIME
  • Transformations Care Network is an established network of behavioral health clinics that, out of a passion for providing superior patient care, is empowering our clinicians and customer service teams ...
  • 2 Days Ago

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Network Provider Contracting Specialist - Peak Health
  • Allied Health Solutions
  • Morgantown, WV FULL_TIME
  • Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. B...
  • 19 Days Ago

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MHN IS Network Manager
  • Cabell Huntington Hospital/St. Mary
  • Huntington, WV FULL_TIME
  • Reporting to the Director of Technical Services, the IS Network Manager is responsible for the operation and support of all networking, telephony, and other unified communications. System Specific Dut...
  • 12 Days Ago

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Manager Provider Relations
  • Highmark Inc.
  • Remote Position, WV FULL_TIME
  • Company : Highmark Inc. Job Description : JOB SUMMARY This job manages a team of provider relations’ representatives and staff to provide high quality service to providers participating in the organiz...
  • 3 Days Ago

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Manager Provider Relations
  • Highmark Inc.
  • UNKNOWN, WV FULL_TIME
  • Company : Highmark Inc. Job Description : JOB SUMMARY This job manages a team of provider relations’ representatives and staff to provide high quality service to providers participating in the organiz...
  • 3 Days Ago

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In-House IPA Representative
  • MedPOINT Management
  • Los Angeles, CA
  • Job Description Job Description Summary Under the general direction of the Provider Network Operations (PNO) – Network M...
  • 3/29/2024 12:00:00 AM

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Program Project Specialist 1
  • Arizona Department of Administration
  • Phoenix, AZ
  • Program Project Specialist 1 Job No: 524722 Work Type: Full-time Location: REMOTE OPTIONS, PHOENIX Categories: Administr...
  • 3/29/2024 12:00:00 AM

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Manager Provider Network Management
  • AmeriHealth Caritas
  • Palm Beach Gardens, FL
  • **Manager Provider Network Management** Location: Palm Beach Gardens, FL Primary Job Function: Medical Management ID**: ...
  • 3/28/2024 12:00:00 AM

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Regional Provider Network Manager (Midwest region)
  • Christian Care Ministry
  • Nashville, TN
  • The range for this role is $70,000 - $95,000 Actual base pay will be determined based on a successful candidate's work l...
  • 3/28/2024 12:00:00 AM

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Operations Analyst: PE (Part-Time)
  • CertifyOS
  • New York, NY
  • OPERATIONS ANALYST: Payor Enrollment Remote | USA About CertifyOS: We are on a mission to change how the US healthcare i...
  • 3/28/2024 12:00:00 AM

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Service Provider Manager (SPM) (Referral Management Clerk) - Eglin AFB, FL
  • Reef Systems
  • Eglin Afb, FL
  • Service Provider Manager (SPM) (Referral Management Clerk) - Eglin AFB, FL Background/Experience : Shall read, understan...
  • 3/27/2024 12:00:00 AM

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Sales AVP or higher - Digital and IT services - Healthcare payer sector
  • Confidential
  • Valenco Inc. (www.valencoinc.com) is an executive search company focused on sales and sales leadership roles for the tec...
  • 3/27/2024 12:00:00 AM

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Operations Manager - Provider Management
  • CorVel
  • Fort Worth, TX
  • The CERIS Operations Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Qua...
  • 3/26/2024 12:00:00 AM

West Virginia (/vərˈdʒɪniə/ (listen)) is a state located in the Appalachian region in the Southern United States and is also considered to be a part of the Middle Atlantic States. It is bordered by Pennsylvania to the north, Maryland to the east and northeast, Virginia to the southeast, Kentucky to the southwest, and Ohio to the northwest. West Virginia is the 41st largest state by area, and is ranked 38th in population. The capital and largest city is Charleston. West Virginia became a state following the Wheeling Conventions of 1861, after the American Civil War had begun. Delegates from so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for PROVIDER NETWORK MANAGER jobs
$96,735 to $121,203

PROVIDER NETWORK MANAGER in Tucson, AZ
There are different Location Providers, which one is the most accurate? The GPS Provider or the Network Provider.
January 08, 2020
PROVIDER NETWORK MANAGER in Saint Louis, MO
Healthcare providers are continually struggling with the increasing pressure to cut down on patient costing, providing higher quality service, increased accessibility, etc.
January 10, 2020
PROVIDER NETWORK MANAGER in Norfolk, VA
5+ years of experience in a network management-related role, such as contracting or provider services.
February 05, 2020