Senior Manager, Provider Contracting

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

Benefits offered by this job

Hybrid work model

Remote Flex

Hybrid-Flex role

Job summary

Blue Cross and Blue Shield of North Carolina seeks a senior leader to manage and advance complex provider reimbursement initiatives within a broad network of integrated delivery systems. The role emphasizes negotiation, collaboration with hospitals, and strategic provider relationships to maintain network leadership.

You will lead a team, guide feasibility modeling, and align contracting strategies with medical expense targets, in a Hybrid Flex environment based near Durham, NC.

Qualifications

• Bachelor’s or advanced degree required.
• 8+ years of experience; in lieu of degree, 10+ years.
• Executive level provider relationship experience essential.
• High-complexity provider contracting with value and pay-for-performance models.
• Experience with cross-functional health plan teams.

Responsibilities

• Lead team managing complex provider reimbursement initiatives with integrated systems.
• Lead contracting team for provider network strategies.
• Drive and facilitate innovative provider network opportunities and negotiate contracts.
• Coordinate discussions with internal/external stakeholders to align network initiatives.
• Collaborate to allocate resources for strategic network initiatives.
• Lead negotiations with key providers such as academic medical centers.
• Develop feasibility models and forecast contracting impact.
• Develop strategy to meet medical expense targets.

Skills

Provider reimbursement initiatives

Provider network strategies

Contract negotiations

Relationship management

Education

Bachelor’s degree or higher

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.

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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

*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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