Senior Manager, Provider Contracting

NC Health Affiliates; Durham (NC); Hybrid; USD 131,000 - 209,000; Full time

Benefits offered by this job

Health benefits

Parental leave

Tuition reimbursement

401k match

Hybrid Flex environment

Work-life balance

Job summary

Blue Cross NC seeks an executive-level leader to manage the assessment, development, and negotiation of the most complex provider reimbursement initiatives with integrated delivery systems and key providers. The role directs a contracts-focused team and collaborates across stakeholders to ensure strategic network opportunities are implemented effectively.

In addition to strong financial modeling and cost of care insights, the position requires extensive provider relationship experience and the

Qualifications

• Bachelor’s or advanced degree where required; in lieu of degree, 10+ years’ experience.
• 8+ years of experience in leadership and contract-related roles.
• Executive-level provider relationship experience is essential.

Responsibilities

• Lead team responsible for assessment, development, articulation, negotiation and implementation of complex provider reimbursement initiatives.
• Oversee relationships with integrated delivery systems, hospital systems and key providers.
• Direct contracting team on building relationships, research, analysis, development and negotiation of network strategies.
• Drive next-generation provider network opportunities and implement strategies into contracts.
• Collaborate with internal stakeholders to allocate resources (FTEs, technology, etc).
• Lead negotiations with academic medical centers and multispecialty providers.
• Develop feasibility models and forecast financial impact of contracting strategies.
• Develop strategies to ensure medical expense targets are met.

Skills

Budgeting

Business Development

Collaboration

Contracting Strategies

Contract Negotiations

Healthcare Operations

Network Development

Policy Development

Education

Bachelor's degree

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

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in‑person connection - that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid‑Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work 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