Provider Strategy & Compliance Lead

Horizon-Blue-Cross-Blue-Shield-of-New-Jersey; Newark (NJ); On-site; USD 79,000 - 106,000; 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 seeks a Provider Relations professional to coordinate cross‑department initiatives and ensure regulatory and accreditation compliance. The role interfaces with management to implement action plans and drive network improvements.

You will develop communications, support physician contracting processes, and coordinate education content for internal and external audiences, contributing to CAHPS and HEDIS outcomes.

Qualifications

• Bachelor's degree or equivalent business experience in healthcare administration, finance, marketing or communications.
• 3–5 years experience in provider relations.
• Knowledge of managed care principles including capitation and PPOs.

Responsibilities

• Research, coordinate and oversee development of special projects and reports for management and regulatory requirements.
• Ensure network compliance and identify deficiencies affecting consistency.
• Develop, implement and drive action plans to improve CAHPS and HEDIS scores.
• Coordinate education materials and physician communications; support cross‑functional teams on network initiatives.
• Prepare responses to RFIs/RFPs regarding physician network and contracting standards.

Skills

Written communication

Verbal communication

Presentation skills

Independent work

Analytical skills

Problem solving

Negotiation

Time management

Education

Bachelor's degree in business healthcare administration, finance, marketing or communications

Tools

Microsoft Access

Lotus Notes

Microsoft Word

Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a Provider Relations professional to coordinate cross‑department initiatives and ensure regulatory and accreditation compliance. The role interfaces with management to implement action plans and drive network improvements.

You will develop communications, support physician contracting processes, and coordinate education content for internal and external audiences, contributing to CAHPS and HEDIS outcomes.