Provider Network Executive IV

Workforce Classification:

Join Our Team: Do Meaningful Work and Improve People’s Lives 

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

About the role of Senior Provider Network Executive

The Sr. Provider Network Executive (PNE IV) develops and maintains effective relationships with Premera’s most strategic and complex provider accounts to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values.  In this highly visible role, the PNE IV is responsible for the negotiation and management of Premera’s most complex and critical provider relationships across the state of Washington.  Success in this position is integral in supporting Premera’s strategy, as well as the implementation of new products through engagement and negotiating with providers to facilitate their support and acceptance of the various strategies and products Premera implements.

What you’ll do:

• Develop and execute ongoing account management and service strategies to meet corporate strategic / financial objectives.
• Lead negotiation and implementation of complex, multifaceted provider contracts.
• Complete negotiations within preplanned targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts.
• Serve as the main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
• Build and maintain positive relationships, generally with the most complex and significant provider/systems. Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment.
• Develop and maintain effective multifaceted and strategic provider networks, with complex payment methodologies and alternate funding arrangements. Participate in payment and delivery systems innovation initiatives.
• Monitor and analyze financial and quality metrics to assess effectiveness of networks, reports findings to leadership, and creates action plan.
• Develop strong understanding of providers’ business drivers and performance.
• Collaborate with Healthcare Economics in rate development and proposal analysis.
• Lead a high-level, cross-functional team to provide operationally excellent service and support to strategic accounts.
• Consult and educate assigned account and internal leadership, providing industry and cross-market expertise. Create provider specific and public presentations.
• Provide input and/or drive development of payment methodologies and provider engagement strategies
• Advise Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
• Engage providers to promote the concept and understanding of patient engagement adherence, cost savings programs
• Other duties and projects as assigned.

What you’ll bring

• Bachelor’s degree or four (4) years of experience in a provider or payer environment. (Required)
• Six (6) years of experience in payer or provider contracting and managing provider relationships in the health care or insurance industry to include:
  • Four (4) years of experience negotiating contracts. (Required)
• Master’s degree in a related field. (Preferred)
• Strong acumen around contract language negotiations. (Preferred)
• Analytical skills.
• Working knowledge of the Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
• Demonstrated ability to effectively negotiate complex and multi-faceted contracts.
• Working knowledge of complex and alternate funding arrangements and payment methodologies, i.e., gain sharing, risk strategies.
• Demonstrated successful verbal and written communication skills including ability to develop and deliver executive and public presentations, training, and meeting facilitation.
• Knowledge of network development and provider/vendor network recruitment.
• Knowledge of provider community and market anomalies.
• Demonstrated ability to develop and execute strategy.
• Independent work style, self-motivated with ability to lead with minimal direction.
• Strong analytical skills and problem-solving skills.
• Results driven with measurable outcomes.
• Proven ability to lead and direct teams addressing complex issues.
• Strong interpersonal skills coupled with the ability to foster positive working relationships.
• Strong organizational, planning and administrative skills.
• Ability to work under pressure with tight timelines, limited resources, competing priorities and manage project timelines.

Working Environment:

• Work is performed within a normal office environment with ambient temperatures.
• Ability to travel; overnight as required.
• Ability to attend scheduled meetings at providers’ offices.

Physical Requirements:
The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:
This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person and over the telephone.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

National Plus Salary Range:

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.