What are the responsibilities and job description for the Provider Network Manager I/II position at Blue Cross of Idaho?
Develop and maintain positive working relationships with contracted providers. Actively audit and monitor financial performance of all assigned providers to ensure network sustainability. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners. Ensure accurate implementation and administration of contracts.
We Are Looking For a Provider Network Manager With
Level I: 4 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Level II: 6 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Education: Bachelor’s degree or equivalent work experience (Two years’ work experience is equivalent to one year of college)
What a day of a Provider Network Manager may look like:
The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.
We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.
We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.
Reasonable Accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
We Are Looking For a Provider Network Manager With
Level I: 4 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Level II: 6 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Education: Bachelor’s degree or equivalent work experience (Two years’ work experience is equivalent to one year of college)
What a day of a Provider Network Manager may look like:
- Analyze, review, and project financial impacts of network arrangements.
- Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation.
- Ensure accurate implementation and administration of executed networks and/or programs.
- Implement reimbursement strategies designed to control healthcare costs.
- Use data from multiple sources to recommend innovative payment initiatives and methodologies.
- Prepare and present financial performance reports on assigned networks to leadership.
- Formulate, analyze, coordinate, and negotiate contracts with provider networks.
- Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements.
- Prepare and present to healthcare organizations, clients, and internal business partners.
- Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs.
- May identify provider payment or utilization variations and take action to resolve. Communicates variations to leadership.
- Perform other duties and responsibilities as assigned.
The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.
We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.
We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.
Reasonable Accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Salary : $76,346 - $141,100