Network Manager

Lumeris Saint Louis , MO 63150

Posted 1 week ago

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, you'll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris.

Position:Network Manager

Position Summary:
Reporting to the corporate Director of Contract Management, in this position you will be responsible for: the recruitment of new physicians and ancillary providers of health care services; maintaining working relationships with network providers; assessment of provider training needs and the coordination of training programs with Essence staff.

Job Description:

Role and Responsibilities:

  • This position is accountable and responsible for provider network development and maintenance of network adequacy in the Essence market area:

  • Recruits and negotiates physician and ancillary service contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals;

  • Establishes and maintains ongoing relationships with the business leadership of Essence network of physicians and ancillary providers;

  • Assists in the evaluation of network adequacy by provider type, specialty and/or category; designs and implements contracting strategies to meet Essence network needs and the demands of the provider community;

  • Monitors provider contract performance to ensure financial, operational and strategic objectives are being satisfied;

  • Serves as the primary point of contact for provider office staff in answering questions about contract issues and interpretations and, with the assistance of management, resolve any issues that may arise;

  • Provides in-office training and orientation for new providers regarding Essence products and related polices and operations.

  • Serve as Subject Matter Expert on provider types as assigned.

  • Participates in the strategic planning process to address the provider network needs as the Essence market grows.

Experience, Qualifications, and Education:

  • Bachelor's degree in business, health care administration, or related field preferred;

  • Significant experience (usually 3 or more years) with a combination of exposure to provider network contracting and/or provider relations;

  • General knowledge of provider credentialing;

  • Must be: self-motivated; dependable; team and goal-oriented;

  • Must have the ability to communicate effectively with diverse groups, all levels of management and staff, internal as well as external to Essence;

  • Must be patient and able to calmly address and resolve issues in high stress situations;

  • Must possess strong analytic and problem-solving abilities; excellent time management and organizational skills; and excellent computer skills, including Microsoft Office Suite;

  • Must have reliable transportation, as significant local travel will be required.

Lumeris is an EEO/AA employer M/F/V/D.

Location:St. Louis, MO

Time Type:Full time

Status:


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Network Manager

Aetna Inc.

Posted 2 days ago

VIEW JOBS 4/23/2019 12:00:00 AM 2019-07-22T00:00 Job Description POSITION SUMMARY: This position can sit in our Urbandale IA or St. Louis, MO. Aetna Office. Negotiates, executes, conducts high level review and analysis, dispute resoltution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Fundamental Components: Negotiates and executes, conducts high level review and analysis, dispute resoltution and/or settelement negotiations of contracts with larger and more complex, market-based, group/system providers. Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Serves as SME for less experienced team members and internal partners. Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities. May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. BACKGROUND/EXPERIENCE desired: Strong communication, critical thinking, problem resolution and interpersonal skills. 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups. Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements. EDUCATION: The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. FUNCTIONAL EXPERIENCES: Functional - Network Management/Contract negotiation/4-6 Years Functional - Network Management/Physician recruiting - medical/4-6 Years Functional - Network Management/Provider relations/4-6 Years TECHNOLOGY EXPERIENCES: Technical - Desktop Tools/Microsoft Outlook//End User Technical - Desktop Tools/Microsoft Word//End User REQUIRED SKILLS" Sales/Managing Competitive Networks/MASTERY Leadership/Developing and Executing Strategy/ADVANCED Sales/Negotiating collaboratively/MASTERY DESIRED SKILLS: General Business/Demonstrating Business and Industry Acumen/ADVANCED Benefits Management/Interacting with Medical Professionals/MASTERY ADDITIONAL JOB INFORMATION: Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately. #LI-HH1 Aetna Inc. Saint Louis MO

Network Manager

Lumeris