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Sr. Provider Network Manager * Must reside in AZ* at Evolent Health

Sr. Provider Network Manager * Must reside in AZ*

Evolent Health Atlanta, GA Full-Time
**Your Future Evolves Here**

New Century Health (NCH) has been transforming the delivery of specialty care and driving radical cost and quality improvement across the member journey for patients with cancer and cardiovascular disease. As part of Evolent Health, we are on a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

**Why We're Worth the Application:**

+ We continue to grow year over year.

+ Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts ([ Link removed ] - Click here to apply to Sr. Provider Network Manager * Must reside in AZ* .

+ Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.

+ Named to's 2020 list of the best companies for women to advance ([ Link removed ] - Click here to apply to Sr. Provider Network Manager * Must reside in AZ* .

+ Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.

+ Published an annual DE&I report ([ Link removed ] - Click here to apply to Sr. Provider Network Manager * Must reside in AZ* to share our progress on how we're building an equitable workplace.

**What You'll Be Doing:**

**What You'll Be Doing:**

The Sr. Provider Network Manager is primarily responsible for provider engagement which includes contracting, performance management, and maintaining positive working relationships with all assigned program participating providers. This role serves as the liaison between provider and New Century Health's internal departments to address and resolve issues as needed. The Sr. Provider Network Manager conducts provider in-servicing which provides a clear interpretation of organization's policies and procedures related to various administrative/operations functions. Provides continuous provider education to all network providers. Other responsibilities include:

+ Responsible for network development activities including but not limited to assessing strategic market dynamics and plan needs, identifying provider targets while meeting access standards, where applicable, negotiate market competitive provider agreements including fee for service schedules, pay for performance, value based alternative payment models and single case agreements.

+ Tightly manages assigned practices relative to provider performance, analyzing network's quality benchmark results, missed opportunities, cost effectiveness, marketability, stability, and accessibility.

+ Identifies outliers and works closely with other internal department in strategizing how best to be improve performance while minimizing provider abrasion.

+ Responsible for all new market implementation activities related to provider onboarding, to include but not limited to, coordination and facilitation of key provider and or client introductory meetings, and deep-dive markets sessions.

+ Manages and helps mitigate specialty leakage by identifying root cause, addresses ways to resolve both internally and through provider and/or health plan education.

+ Meets with practice leadership regularly to share performance results, identifies areas of opportunities for both NCH and provider, while deepening relationships at all levels within practice.

+ Trains new team members.

+ Represents the company in JOC meetings with current providers and/or clients.

**The Experience You'll Need (Required):**

+ Bachelor's degree and/or minimum of 6-9 years relevant work experience

+ Strong background with deep understanding of fundamental operational processes which directly affect providers and organization such as Claims and Prior Authorization

+ Excellent verbal, writing and presentation skills, and interpersonal skills

+ Extremely organized and detail oriented with exceptional follow through skills

+ Ability to multi-task in a fast pace environment; can adapt quickly to change

+ Ability to influence change to improve provider experience

+ Strong knowledge of Microsoft programs (i.e. Word, Excel, SharePoint)

+ Ability to travel as needed (% depends on market)

+ Experience in healthcare administration with strong emphasis in Provider Operations and/or Network Development/Provider Contracting strategies

+ Strong negotiations skills

**Touches (Preferred):**

+ Bilingual English/Spanish preferred

**Technical Requirements:**

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.

**Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.**

Compensation Range: The minimum salary for this position is $70,000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

Recommended Skills

  • Administration
  • Attention To Detail
  • Claim Processing
  • English
  • Health Administration
  • Interpersonal Skills
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