Provider Network Executive III

Workforce Classification:

Hybrid

 

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.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

About the role of the Provider Network Executive III

The Provider Network Executive III (PNE III) develops and maintains effective relationships with a variety of Premera’s key custom provider accounts to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values.  In this highly visible role, the PNE III is responsible for the negotiation and management of Premera’s strategic provider relationships across the state of Washington.  Success in this position is essential to support Premera’s broader strategy, including the successful implementation of new products through effective provider engagement and negotiation to ensure alignment, support and adoption.

What you’ll do:

• Develop and execute ongoing account management and service strategy to meet corporate strategic / financial objectives.
• Serve as main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
• 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.
• Develop and maintain effective provider networks (standard and custom), often with complex payment methodologies. Participate in payment and delivery systems innovation initiatives.
• 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.
• Collaborate with Healthcare Economics in rate development and proposal analysis.
• Establish and lead a multi-disciplinary team to provide operationally excellent service and support to assigned accounts.
• Consult and educate assigned accounts and internal stakeholders, providing industry and cross account expertise. Create provider specific and public presentations.
• 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.
• Engage providers to promote the concept and understanding of patient engagement adherence, cost savings preventative programs
• Other duties and projects as assigned.

What you’ll bring

• Bachelor’s degree or four (4) years of experience in a provider or payer environment. (Required)
• Four (4) years of experience in payer or provider contracting and managing provider relationships in health care or insurance industry to include:
  • Two (2) years of experience negotiating contracts. (Required)
• Master’s degree in a related field. (Preferred)
• Project management experience. (Preferred)
• Hospital contract negotiation experience. (Preferred)
• Working knowledge of Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
• Knowledge of network development and provider/vendor network recruitment.
• Knowledge of provider community and market anomalies.
• Demonstrated ability to effectively manage complex contract negotiations.
• Demonstrated ability to develop and execute strategy.
• Strong experience and expertise in Provider Relations.
• Independent work style, self-motivated, with ability to lead with minimal direction.
• Demonstrated successful verbal and written communication skills including ability to develop and deliver public presentations, training, meeting facilitation, and broker presentations.
• Strong analytical skills and problem-solving skills.
• Proven ability to lead and direct teams addressing complex issues.
• Strong interpersonal skills coupled with the ability to foster positive working relationships.
• Strong organizational, planning and administrative skills.
• Ability to work under pressure with tight timelines, limited resources, competing priorities and manage to specific project timelines.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

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 careers@premera.com or via phone at 425-918-4785.

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.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Plus Salary Range:

$92,400.00 - $157,100.00

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

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.