The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
*This employee will be remote and working East Coast hours
Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for claimants; foster growth of products; and enhance profitability of Coventry.
Negotiates, executes, reviews, and analyzes contracts with smaller providers (i.e. local, individual providers, small groups/systems, ancillaries) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, financial goals, cost initiatives, and client satisfaction.
Manages contract performance in support of network quality, availability, and financial goals and strategies.
Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.
Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities.
Mayoptimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
- Proven working knowledge of competitor strategies, complex contracting options, value based contracting, and financial/contracting arrangements
- 2+ years related experience, proven and proficient negotiating skills.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Managed care/insurance/workers' comp industry experience
We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. The Company is an equal opportunity employer, values the diversity of our workforce and the knowledge of our people. The Company does not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. #LI-CC2 #LI-Remote