Job Description
Manages team leading the assessment, development, articulation, negotiation, implementation, oversight and management of the most complex enterprise and divisional innovative provider reimbursement initiatives to be implemented with integrated healthcare delivery systems, hospital systems and key healthcare independent providers. Lead team efforts to ensure Blue Cross NC holds a leading provider network capabilities position in the provider network dimension.
Limited travel is required within the state of NC. Candidates for this role must live in NC. Onsite expectations will be discussed during the interview process.
What You’ll Do
Responsible for team leading the relationship management, assessment, development, articulation, negotiation, implementation and relationship management of the most complex enterprise and divisional innovative provider reimbursement initiatives to be implemented with integrated healthcare delivery systems, hospital systems and key healthcare providers
Leads contracting team responsible for building relationships, research, analysis, development, implementation and negotiation of innovative provider network strategies,
Accountable for driving and facilitating next generation, innovative global provider network opportunities, recommending strategies, gaining approval for select provider strategies, implementing through negotiations those strategies into provider contracts, and ensuring effective use of Plan resources to administer approved strategies.
Responsible for the team that leads select internal and external (BCBSA, vendors, etc) discussions regarding network providers and strategies to ensure Network Management has direct input into these initiatives and establish consistency within Blue Cross NC and (where feasible) among other Blues Plans.
Responsible for collaboration and coordination with all internal stakeholders to ensure the assignment of resources (FTEs, Technology, etc) necessary to successfully implement the strategic network initiatives.
Leads team responsible for building successful, collaborative relationships and direct provider negotiations with key providers, such as academic medical centers and multispecialty professional providers.
Leads team responsible for the development of feasibility models and forecasting the performance impact of contracting strategies
Develop strategy to ensure medical expense targets are met
What You Give
Bachelor's or advanced degree where required (where required)
8+ Years of Experience
In lieu of degree, 10+ years' experience.
What We Like
Prior people leader experience, leading teams in size 5-10 managing contract dollars upwards of $5 billion.
Executive level provider relationship experience is essential.
High-complexity provider contracting experience—experience with various reimbursement models including value and pay for performance models.
Demonstrated understanding of financial modeling and cost of care impacts.
Demonstrated experience working with cross functional teams within a health plan.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more
Where You’ll Work
Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.
In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that…