Senior Manager, Provider Contracting

Blue Cross and Blue Shield of North Carolina; Durham (NC); Hybrid; USD 131,000 - 209,000; Full time

Benefits offered by this job

Medical coverage

401k match

Paid time off (PTO)

Annual incentive bonus

Tuition reimbursement

Parental leave

Job summary

Blue Cross NC seeks an experienced leader to manage a team driving complex provider reimbursement initiatives with integrated delivery systems and hospitals across North Carolina. The role focuses on strategic network opportunities, contract negotiations, and cross-functional collaboration to ensure competitive network capabilities.

The position requires 8+ years of experience and a Bachelor’s or advanced degree, with limited travel within NC.

Qualifications

• Bachelor's or advanced degree required wherever stated.
• 8+ years of experience.
• In lieu of a degree, 10+ years of experience.

Responsibilities

• Lead the assessment, development, articulation, negotiation and implementation of complex provider reimbursement initiatives.
• Head contracting team to build relationships and negotiate provider network strategies.
• Drive next-generation provider network opportunities and ensure contracts reflect approved strategies.
• Coordinate with internal stakeholders to allocate resources for strategic network initiatives.
• Lead negotiations with academic medical centers and multispecialty providers.
• Develop feasibility models and forecast the impact of contracting strategies.

Skills

Budgeting

Contracting

Provider Relations

Project Management

Education

Bachelor's or advanced degree

Job description

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

WhereYou'llWork

Our Hybrid Flex approach is built on presencewith a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplacethat'sflexible, connected, and future focused.

In a Hybrid-Flex role,you'llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you'llwork virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$130,560.00 - $208,896.00

Skills

Budgeting, Business Development, Collaboration, Contracting Strategies, Contract Negotiations, Healthcare Operations, Network Development, Policy Development, Project Management, Provider Contracts, Provider Relations, Quality Improvement, Regulatory Compliance, Resource Planning, Stakeholder Management, Strategic Alliances

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