Senior Manager, Provider Contracting

Habitat For Humanity Of Durham; Durham (NC); Hybrid; USD 131,000 - 209,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) match

Paid time off

Job summary

Blue Cross NC is seeking a senior leader to manage complex provider reimbursement initiatives across integrated healthcare delivery systems and hospitals. You will oversee the contracting and network strategies, negotiate with major providers, and drive feasibility models to forecast performance and costs.

The role requires collaboration with internal stakeholders, limited travel within North Carolina, and a hybrid/onsite work arrangement.

Qualifications

• Bachelor's or advanced degree required.
• 8+ years of experience in health plan or provider contracting.
• In lieu of degree, 10+ years experience.

Responsibilities

• Lead team to manage complex provider reimbursement initiatives with healthcare systems and providers.
• Lead contracting team for innovative provider network strategies.
• Drive and negotiate contracts and provider network opportunities.
• Collaborate with internal stakeholders to allocate resources (FTEs, technology).
• Lead negotiations with academic medical centers and multispecialty providers.
• Develop feasibility models forecasting contracting impacts and cost of care.

Skills

People leadership

Provider contracting

Financial modeling

Healthcare networks

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.

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

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

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