Provider Network Manager

Blue Cross of Idaho is looking for a Provider Network Manager be a part of the Provider Contracting team! This role will be responsible for the management, operation, direction, organization, and administration of hospital contracts. Ensure network contracts provide cost effective outcomes.

Develop and maintain positive working relationships with contracted hospitals. Contract and negotiate with the most complex providers. Actively audit and monitor financial performance of all assigned hospitals to ensure accurate implementation and administration of contracts. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners.

This position can be remote within a mutually acceptable location. #LI-Remote

Minimum 6 years' provider contract management/network management, provider and hospital reimbursement methodologies, contract language negotiation, or relevant experience

• 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:

• Develop the provider network through contract negotiations, relationship development, industry analysis and servicing.
• Contract and negotiate with the most complex providers. Complex providers may include, but are not limited to, large hospital systems, large medical groups and ancillary providers, providers in areas where strong competition or greater provider education around managed care concepts is required.
• Analyze, review, and project financial impacts of network contract arrangements.
• Ensure accurate implementation and administration of executed network contracts and/or programs.
• Implement reimbursement strategies designed to control healthcare costs.
• Utilize data from multiple sources to recommend innovative payment initiatives and methodologies.
• Serve as a communication link between providers and Blue Cross of Idaho
• Prepare and present contract proposals and financial performance reports on assigned networks Hospitals to leadership.
• 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.
• Establish productive, professional provider relationships with key stakeholders and maintains provider satisfaction through assessment and response to on-going provider needs.
• May identify provider payment or utilization variations

As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $ 144,275 . The position is eligible for an annual incentive bonus (variable depending on company and employee performance).

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.

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.