Manager, Network & Physician Contracting

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 120,000 - 180,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a leader to steer the development, negotiation, management, and maintenance of provider contracts across physician organizations, hospitals, and ancillary facilities. The role emphasizes hospital contracting experience in a leadership capacity and collaboration across multiple teams to advance payment models.

The position focuses on negotiating terms, aligning with reimbursement standards, and implementing policy-driven contracting

Qualifications

• Hospital contracting experience in a leadership role.
• Experience with fee-for-service (FFS) and value-based payment contracting initiatives.
• Ability to negotiate provider contracts with hospital executives, physicians, and ancillary providers.
• Experience developing and implementing contracting strategies in healthcare networks.

Responsibilities

• Lead and support development, negotiation, management, and maintenance of provider contracts.
• Collaborate on fee-for-service and value-based payment contracting initiatives with the Director.
• Work with payment evolution and provider experience teams to meet contracting objectives.
• Draft and negotiate provider rate proposals with Medical Economics and Actuary departments.
• Ensure contracting activities comply with Horizon reimbursement standards and regulatory requirements.

Job description

Horizon is committed to providing innovative healthcare solutions and fostering a culture of collaboration and inclusivity.

About the Role

The role involves leading and supporting the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospitals, and ancillary facilities across the payment spectrum.

*Candidate MUST have Hospital Contracting experience (current or previous) in a leadership role.

Responsibilities

• Lead/support the development, negotiation, management, and maintenance of provider contracts.
• Work with the Director on fee-for-service (FFS) and value-based payment contracting initiatives.
• Collaborate with the payment evolution team to introduce updated payment models.
• Collaborate with the provider experience team to meet provider expectations.
• Lead/support complex negotiations and/or contracting arrangements.
• Develop a sound business strategy for financial and legal terms required for contracting initiatives.
• Work with Medical Economics and Actuary Department to draft provider rate proposals.
• Negotiate proposals with hospital executives, physicians, and ancillary providers directly.
• Manage the development and execution of the network contracting strategy.
• Adopt value-based contracting for providers operating under fee-for-service models.
• Minimize special arrangements and align to enterprise affordability objectives.
• Manage and negotiate contracts in compliance with Horizon reimbursement standards.
• Assist and implement provider contracting policies and procedures consistent with industry best practices and regulatory requirements.
• Hospital contracting experience strongly preferred.