Job Information
Elevance Health Director Specialty Network Management in SEVEN HILLS, Ohio
Director Specialty Network Management
Location: This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of an Elevance Health location.
The Director Specialty Network Management directs strategy and processes around development, implementation, and management of multiple Centers of Clinical Excellence (CCE) networks and providers of specialty services (e.g. transplant, select gene therapy, CAR-T, bariatric, cardiac) that have met specific criteria for quality of care.
How you will make an impact:
Develops strategy and network development for specialty services.
Develops strategy for enterprise-wide Centers of Clinical Excellence contracting in multiple disciplines (transplant, select gene therapy, CAR-T, bariatric, cardiac, etc.).
Coordinates distribution of RFP/RFI, reviews of responses, assists in development of quality criteria, analysis of claims data and implementation of contracting strategy.
Oversees single case specialty agreements.
Oversees agreement negotiations with local contracting staff and contracting directly with specialty providers and facilities.
Responsible for education to Care Management and local network teams on single case agreement process for new and emerging services, and contracting activity.
Directly manages transplant claims payments for a region.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Requirements:
- Requires a BS/BA degree in business administration or related healthcare field and a minimum of 6 years of managed care experience; managerial and project management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Strongly preferred CPA or MBA degree.
Experience with transplant and specialty care contracting/operations strongly preferred.
Network build experience.
Commercial, Medicare or Medicaid lines of business knowledge.
Clinical understanding of specialty services along with strong analytical skills.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $136,880 to $258,703.
Locations: California; Colorado; Hawaii; New York; Nevada, Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.