Provider Network Executive Iii

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

Forbes ranked Premera among America’s 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

As a Provider Network Executive III, you will develop and maintain effective relationships with strategic or core provider accounts, generally custom or complex in nature, to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values. You will negotiate standard to complex agreements, often with innovative funding arrangements, and manage ongoing provider relationships.

This is a virtual/telecommuter position, working from home.

What you’ll do:

• Serve as main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
• Develop and maintain effective provider networks (standard and custom), often with complex payment methodologies. Participate in payment and delivery systems innovation initiatives.
• Consult and educate assigned accounts and internal stakeholders, providing industry and cross account expertise. Create provider specific and public presentations.
• Lead negotiation and implementation of complex or custom provider contracts.
• Complete negotiations within preplanned rate targets, meet timelines, ensure the established implementation period, and perform implementation audits for accuracy of assigned accounts.
• Establish and lead a multi-disciplinary team to provide operationally excellent service and support to assigned accounts.
• May also be the lead for the PNE team in resolution of escalated provider concerns/issues, distribution of workload, and provide peer review for contract accuracy. May develop or improve work processes to increase team efficiency.
• Build and maintain positive physician/provider relationships, generally with more complex accounts. Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment. Monitor and analyze network performance.
• Collaborate with Healthcare Economics in rate development and proposal analysis.
• Proactively communicate with Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
• Develop and execute ongoing account management and service strategy to meet corporate strategic/financial objectives.
• Engage providers to promote the concept and understanding of patient engagement adherence and cost savings preventative programs.

What you’ll bring:

• Master’s Degree in a related field preferred.
• Demonstrated ability to develop and execute strategy.
• Bachelor’s Degree or (4) years of experience in a provider or payer environment. (Required)
• Knowledge of provider community and market anomalies.
• Strong experience and expertise in Provider Relations.
• Demonstrated successful verbal and written communication skills including ability to develop and deliver public presentations, training, meeting facilitation, and broker presentations.
• Demonstrated ability to effectively manage complex contract negotiations.
• Project management experience.
• Working knowledge of Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
• (4) years of experience in payer or provider contracting and managing provider relationships in health care or insurance industry including (2) years of experience negotiating contracts. (Required)
• Knowledge of network development and provider/vendor network recruitment.

What We Offer

• Medical, vision and dental coverage
• Free parking
• Life and disability insurance
• Tuition assistance for undergraduate and graduate degrees
• Wellness incentives, onsite services, a discount program and more
• Generous Paid Time Off to reenergize
• Retirement programs (401K employer match and pension plan)

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range:

$75,200.00 - $127,900.00

National Plus Salary Range:

$85,000.00 - $144,500.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.