Provider Network Executive II

General/Other: Medical/Health PREMERA. Applying innovation and strategy to create leading-edge health coverage and benefit solutions for our members. PREMERA’s culture promotes individual development, fosters innovation, and rewards success. We are creative, strategic thinkers who use our talents to fulfill our mission of creating peace of mind for our members. First established in 1933, the PREMERA family of health-care companies is headquartered in Washington and serves over 1.5 million members in several Western States. Our unique value proposition is built on a strong local presence and national capabilities. If you would like to apply your skills and experience to create health-care solutions, consider the following position: Job Summary: The Provider Network Executive II has overall accountability to lead, develop, and maintain strong, positive relationships with strategic, complex provider accounts and/or accounts with a significant material impact to the organization. These responsibilities also include assurance of provider/vendor account satisfaction with Premera, which will facilitate achieving Premera’s operational and strategic goals. The PNE II proactively manages assigned accounts to achieve Premera’s strategy for product and provider contract development. In addition, this position partners with other PNEs, PNAs, and PNRs to ensure continuity of Premera’s vision and values. Responsibilities: Relationship Management • Builds and maintains a positive physician / provider relationships with complex and strategic accounts with a focus on a collaborative approach to quality care, network stability and cost containment. • Fosters relationships between Premera and the provider account at an executive level. • Develops and executes a forward looking account management plan that focuses on account strategy and effective contracting. • Accountable for the relationship management for assigned accounts, which includes establishing a high level multi-disciplinary team to provide operationally excellent service and support to assigned accounts. • Proactively seeks ways to provide value added consulting to assigned provider accounts while focusing on long-term goals of both the provider and Premera. • Consults and educates assigned accounts on Premera’s internal and industry resources. • Provides industry and cross account expertise to strengthen the relationship between Premera and the provider. • Develops and participates in provider specific and public presentations as indicated. Provider Network/Contract Negotiations • Accountable for network contracting results for assigned accounts and efficiently manages resources to achieve department goals and initiatives. • Leads negotiation and implementation of provider contracts and acts as the single point of contact for assigned accounts. • Proactively communicates with HCDS leadership on account status to facilitate proper internal support of account management efforts. • Develops and implements contracting strategies which meet corporate financial objectives; working within the budgetary guidelines. • Completes negotiations within preplanned rate targets, meets timelines, ensures the established implementation period and performs implementation audits for accuracy of assigned accounts. • Communicates with internal stakeholders in the impacted markets the status of contract negotiations and potential impact on operations throughout negotiation process and obtains feedback as appropriate to ensure that the resulting final contract supports Premera's operational and strategic goals. Collaboration/Team Work • Contributes to a positive work environment and corporate culture by demonstrating the five core values. • Participates in various product teams and corporate initiatives to develop and implement value added services. • Effectively collaborates with HCE in rate development and proposal analysis. • Participates in special projects related to the corporate initiatives and other duties as assigned. • Coordinates multi-disciplinary team efforts within and across divisions. • Facilitates achievement of Premera’s operational and strategic goals: demonstrates knowledge and support of Premera corporate initiatives and prioritizes work activities to support them. • Develops proactive and positive working relationships with other departments within Premera to resolve provider issues. Minimum Qualifications: 1. Bachelor’s degree in related field or equivalent work experience. 2. Three to five years experience in managing provider relationships in the health care or insurance industry. 3. Demonstrated ability to effectively manage complex and multi-faceted contract negotiations. 4. Demonstrated ability to develop and execute strategy. 5. Strong experience and expertise in Provider Relations. 6. Self-starter; ability to lead with minimal direction. 7. Demonstrated successful communication skills including public presentation, training, meeting facilitation, broker presentation, and written formats. 8. Strong analytical skills and problem solving skills 9. Results driven with measurable outcomes. 10. Proven ability to lead and direct small to medium sized teams addressing complex issues. 11. Strong interpersonal skills coupled with the ability to foster positive working relationships. 12. Strong organizational, planning and administrative skills. 13. Ability to work under pressure with limited resources, competing priorities and to manage to specific project timelines. 14. Knowledge of provider community and market anomalies, as applicable. 15. Excellent presentation skills. 16. Ability to travel. Additional Qualifications Preferred: 1. Master’s degree in a related field or equivalent experience. 2. Project management experience. 3. Knowledge of regulatory issues; such as HIPAA, PBR. 4. Knowledge of network development and provider/vendor network recruitment Premera Ranked Highest in Member Satisfaction in U.S. West In the J.D. Power and Associates 2007 National Health Insurance Plan Satisfaction Study, Premera achieved the highest member satisfaction with commercial health plans (regional and national companies) serving the western United States.