Manager, Network & Physician Contracting

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 140,000 - 210,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Provider Contracting Lead to drive the development, negotiation, management, and maintenance of provider contracts across physician groups, hospitals, and ancillary facilities.

You will partner with Finance, Legal, Medical Economics, and Actuary teams to shape favorable terms, align with value-based care initiatives, and ensure compliance with Horizon standards.

Qualifications

• Hospital contracting experience strongly preferred.

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.

Skills

Provider contracts

Negotiation

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.

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.