at Elevance Health in CHICAGO, Illinois, United States
Job Description
Sr Director Network Strategy and Performance
+ Job Family: Business Development and Planning
+ Type: Full time
+ Date Posted:May 12, 2023
+ Req #: JR59990
Location:
+ IL, CHICAGO
+ Minnesota, Minneapolis
+ MD, BALTIMORE
+ NJ, MORRISTOWN
+ CA, SAN JOSE
+ IN, INDIANAPOLIS
+ CA, SACRAMENTO
+ CA, IRVINE
+ KY, LOUISVILLE
+ NY, NEW YORK
+ CA, LOS ANGELES
+ WA, SEATTLE
+ NH, MANCHESTER
+ FL, MIAMI
+ TX, SAN ANTONIO
+ TN, NASHVILLE
+ AZ, Phoenix
+ DC, WASHINGTON
+ CO, DENVER
+ VA, NORFOLK
+ OH, COLUMBUS
+ California, San Diego
+ CA, SAN FRANCISCO
+ MO, ST LOUIS
+ CT, WALLINGFORD
+ WI, MADISON
+ Pennsylvania, Philadelphia
+ MA, BOSTON
+ GA, ATLANTA
+ Texas, Dallas
+ TX, HOUSTON
+ Connecticut, Hartford
+ NV, LAS VEGAS
+ Oregon, Portland
+ FL, TAMPA
Description
A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health , is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. Also, a proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS , is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.
Carelon’s Post Acute Solutions and Medical Benefits Management Team is looking to hire a Sr Director of Network Strategy and Performance . The People leader will lead teams dedicated to network development and management, contracting, and provider and network relations. Networks to include Home Health, Post Acute Institutional, Chiropractic, DME, and other specialty or ancillary networking.
Primary duties may include, but are not limited to:
+ Identifies & cultivates strategic alliances & building new network models with significant provider organizations to ensure the health care needs of network members are met.
+ Partners with internal resources to ensure network configuration supports medical trends (UM and unit costs) in order to achieve market growth and budgeted MLR costs.
+ Recognized as the local market expert on provider relations and provider market dynamics. Assists staff, as needed, for strategic planning, during negotiation procedures, or issue resolution with high volume or strategically significant provider groups.
+ Oversight for provider services and network development, including provider education and network management/provider relations support activities, network contracting, network adequacy, geographic/client network expansions, and provider credentialing.
+ Accountable for developing strategies aimed to enhance Provider engagement, diversify MBM and PAS contracting strategies, and develop incentive-based programs which create value for both current and prospective clients, and the Provider community.
+ Develops and refines the Provider Network Performance Management Scorecard, to ensure proper oversight in place of network, including but not limited to state and federal requirements.
+ Oversees Provider network analytics, including expansion overlay requests, performance reporting, Provider scorecards, development of contract modeling tools, network adequacy, client requested deliverables, assists in the refinement of Provider Tableau reporting suite, etc.
+ Responsible for the Provider data management department, and ownership/strategic initiatives related to Salesforce and Virsys12. (PAS)
+ Acts as a liaison for the Provider Network team for prospective client pitches, existing client discussions, and Joint Operating Committee discussions.
+ Assists the MBM and PAS Solutions team to develop future product lines or enhance current product offerings. Engages with strategic Provider partners as necessary during the discovery, implementation, and post go-live phases.
Requires a BA/BS degree in a related field and a minimum of 8 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.
Highly preferred skills and experiences:
-Experience in Leadership roles inside a health plan/ managed care/ health insurance org
-Provider Contracting and Network Management experience at a health plan, preferably with Home Health, Post Acute Institutional, Chiropractic, DME, or other specialty or ancillary networking
-Experience leading other people leaders
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $158,000 to $285,000
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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. A Fortune 20 company with a longstanding history in the healthcare industry, 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 in certain patient/member-facing roles to become vaccinated against CO
