Lead Network Contracting & Value‑Based Negotiations

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 87,000 - 119,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior level professional to lead network provider negotiations across Commercial, Medicare, Medicaid, DSNP, MLTSS and Casualty lines. You will collaborate on rate proposals, contract loading and testing, and drive adoption of value-based contracting across multiple markets.

The role requires deep experience in hospital finance, managed care networks, and regulatory compliance, with a focus on developing policy and procedures to sustain

Qualifications

• Five years of business experience in hospital finance and/or managed care network development.
• Five years demonstrated experience in two or more with in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APC's, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements.
• Five years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs.
• Five years' experience in hospital finance and/or managed care network development.
• Five years' experience in health care cost data analysis and technical document writing.

Responsibilities

• Facilitate and lead network provider negotiations for Horizon's medical lines of business.
• Accountable for accurate implementation of contracts; coordinate with other departments to load contracts correctly.
• Review system-wide claims, configuration, and provider mapping discrepancies and perform root cause analysis.
• Collaborate with Medical Economics and Actuary to prepare rate proposals for all lines of business.
• Coordinate development and submission of hospital, ancillary and professional rate loads and contract storage.
• Ensure contract language templates are maintained and negotiable contracts can be configured into core systems.
• Support the adoption of value-based contracting and alignment with affordability objectives.
• Develop provider contracting policies and procedures aligned with regulatory requirements.
• Collaborate across departments to align provider services with member needs and organizational goals.
• Create materials for industry conferences and webinars.

Skills

Relationship building

Negotiation

Analytical skills

Communication (verbal)

Communication (written)

Education

Bachelor degree in business/finance/health administration

Master's degree in health or business

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior level professional to lead network provider negotiations across Commercial, Medicare, Medicaid, DSNP, MLTSS and Casualty lines. You will collaborate on rate proposals, contract loading and testing, and drive adoption of value-based contracting across multiple markets.

The role requires deep experience in hospital finance, managed care networks, and regulatory compliance, with a focus on developing policy and procedures to sustain