Network Management Consultant

Anthem   •  

Cerritos, CA

Industry: Accounting, Finance & Insurance


Less than 5 years

Posted 37 days ago

This job is no longer available.

he Network Management Consultant serves as CareMore’s face to our contracted Independent physician partners and works directly with the Provider Network Manager and Regional team of the market to improve provider performance and grow CareMore’s footprint. In this role, you would develop and maintain positive relationships with physicians, providers, and practice managers within the provider network. You would develop providers in the network through provider engagement initiatives for quality performance, grow the network through recruitment and simple contract negotiations, and general servicing of provider needs. This position serves as a communication link between providers and the CareMore. This is an independent role, operating with general supervision, expected to elevate unusual situations to management as required. In addition to day-to-day responsibilities, you would also be asked to participate in intradepartmental meetings required. Primary duties may include, but are not limited to:

  • Frequent and consistent visits to office out in the field-value proposition, organizing meetings, organizing PCP dinners, Portal usage/training, onboarding of new providers, training to our model of care, secure completion of PAHAFs and HEDIS elements, train on corporate initiatives
  • Subject matter expert for neighborhood related network Issues: such as claims, authorizations, escalation for grievances and appeals, payment discrepancies, etc. Assist with member/provider issues, answer general network questions, address/educate and/or redirect member/provider related questions and requests for assistance from multiple departments
  • Working with sales to identify opportunities for growth, drive referrals from PCPs, assist with physician events, assist with marketing materials for physician events

Requires a BA/BS degree; 2 years’ experience in provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. Requires travel.