Provider Network Manager I/II
About the position
The Provider Network Manager I/II at Blue Cross of Idaho is responsible for developing and maintaining positive relationships with contracted providers while ensuring the financial performance and sustainability of the provider network. This role involves analyzing contract arrangements, implementing reimbursement strategies, and preparing financial performance reports for leadership. The position requires effective communication with internal partners and the ability to manage provider satisfaction through ongoing assessments and responses to provider needs.
Responsibilities
Develop and maintain positive working relationships with contracted providers.
,
Audit and monitor financial performance of assigned providers to ensure network sustainability.
,
Analyze, review, and project financial impact of contract arrangements.
,
Initiate and maintain effective communication channels with internal business partners.
,
Ensure accurate implementation and administration of contracts.
,
Prepare and present financial performance reports on assigned networks to leadership.
,
Formulate, analyze, coordinate, and negotiate contracts with provider networks.
,
Maintain documentation related to processes and procedures, training materials, and program descriptions.
,
Identify provider payment or utilization variations and take action to resolve them.
Requirements
Bachelor's degree or equivalent work experience.
,
Level I: 4 years' experience in provider contract/network management, provider reimbursement methodologies, contracting, or negotiation.
,
Level II: 6 years' experience in provider contract/network management, provider reimbursement methodologies, contracting, or negotiation.
Nice-to-haves
Benefits
Apply Now
The Provider Network Manager I/II at Blue Cross of Idaho is responsible for developing and maintaining positive relationships with contracted providers while ensuring the financial performance and sustainability of the provider network. This role involves analyzing contract arrangements, implementing reimbursement strategies, and preparing financial performance reports for leadership. The position requires effective communication with internal partners and the ability to manage provider satisfaction through ongoing assessments and responses to provider needs.
Responsibilities
Develop and maintain positive working relationships with contracted providers.
,
Audit and monitor financial performance of assigned providers to ensure network sustainability.
,
Analyze, review, and project financial impact of contract arrangements.
,
Initiate and maintain effective communication channels with internal business partners.
,
Ensure accurate implementation and administration of contracts.
,
Prepare and present financial performance reports on assigned networks to leadership.
,
Formulate, analyze, coordinate, and negotiate contracts with provider networks.
,
Maintain documentation related to processes and procedures, training materials, and program descriptions.
,
Identify provider payment or utilization variations and take action to resolve them.
Requirements
Bachelor's degree or equivalent work experience.
,
Level I: 4 years' experience in provider contract/network management, provider reimbursement methodologies, contracting, or negotiation.
,
Level II: 6 years' experience in provider contract/network management, provider reimbursement methodologies, contracting, or negotiation.
Nice-to-haves
Benefits
Apply Now