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Blue Cross of Idaho · 3 hours ago

Provider Network Manager I/II

Meridian, ID

Full-time

Onsite

Mid, Senior Level

$76K/yr - $141K/yr

4+ years exp

Blue Cross of Idaho is seeking a Provider Network Manager to develop and maintain relationships with contracted providers while monitoring financial performance to ensure network sustainability. The role involves analyzing contract arrangements and implementing reimbursement strategies to control healthcare costs.

Health InsuranceInsurance

Comp. & Benefits

Responsibilities

Analyze, review, and project financial impacts of network arrangements

Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation

Ensure accurate implementation and administration of executed networks and/or programs

Implement reimbursement strategies designed to control healthcare costs

Use data from multiple sources to recommend innovative payment initiatives and methodologies

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, program descriptions and technical program requirements

Prepare and present to healthcare organizations, clients, and internal business partners

Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs

May identify provider payment or utilization variations and take action to resolve. Communicates variations to leadership

Perform other duties and responsibilities as assigned