Premera Blue Cross Director of Provider Network Management in Mountlake Terrace, Washington

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. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

The Director of Provider Network Management will provide leadership to a market for Premera and participate as a member of the Provider Strategy & Solutions (PS&S) Management Team. In this role, you will be actively involved in the ongoing development and implementation of Premera's contracting and provider strategy, including the development of strategies across Premera and all operating companies for assigned markets. You will ensure coordination of efforts with all other and future expansion territories to achieve overall Premera goals.

The Director of Provider Network Management will be involved with establishing policy, development of the provider network, management, planning, and making decisions about provider strategies and support; professional development of team members; liaison support to Premera's external and internal clients; and responsibility for results that contribute to Premera's strategic goals. This position may also serve as a Client Manager for one or more strategic clients.

This position will foster a positive corporate culture within the team and within Provider Strategy & Solutions by promoting and demonstrating the company's vision and values. The Director will provide leadership for a market team including providing employees with opportunities for professional growth; ongoing performance feedback and performance appraisals; coaching for success; removing barriers for achievement of goals, communicating a clear vision and influencing and motivating employees to achieve business results.

What you’ll do

  • Development of overarching Network Strategy for the Medicare Advantage Product in conjunction with MA Product leadership and the Network Management Team.

  • Lead network interactions and communications with CMS

  • Partner with Director, VB Initiatives, on MA payment strategy, including provider incentives

  • Coordinate with Legislative and Government Affairs regarding CMS Network and Program policies

  • Prepare and execute responses to RFP processes as needed for group/system participation. Assure PBC readiness to compete with MA competitors regarding Network administration, data sharing, and performance reporting, administrative efficiency and STARS ratings

  • Assure appropriate Network support in conjunction with MA Operations leadership and Administrative Vendor(s)

  • Lead evaluation of County expansion assessment and rate issues in conjunction with MA Leadership and Pricing

  • Assume overall accountability for unit cost management, provider network stability and provider satisfaction within his/her region.

  • Lead Network participation in any evaluation of MA growth opportunities

What you’ll bring

  • Bachelor’s degree or four years’ work experience.

  • Ten years of health care management experience (Managed Care, HMO, and BCBS) hospital or clinic.

  • Six years of management experience.

  • Demonstrated experience with Medicare Advantage Network Management

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What we offer

  • Medical, vision and dental coverage

  • Life and disability insurance

  • Retirement programs (401K employer match and pension plan)

  • Wellness incentives, onsite services, a discount program and more

  • Tuition assistance for undergraduate and graduate degrees

  • Generous Paid Time Off to reenergize

  • Free parking

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.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.