Senior Manager, Provider Contracting

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and surrogacy support

401k match with company contribution

Job summary

Blue Cross NC is seeking a senior leader to direct complex enterprise provider reimbursement initiatives and negotiate strategic provider contracts with academic medical centers and multispecialty providers. You will lead a contracts team, drive cross-functional collaboration, and align network strategies with financial targets.

The role requires 8+ years of experience, a Bachelor's degree or equivalent, and executive-level relationship management.

Qualifications

• Bachelor’s or advanced degree where required (8+ Years).
• 8+ years of experience in lieu of degree.
• Executive level provider relationship experience is essential.

Responsibilities

• Lead relationship management and provider negotiations with academic medical centers and major providers.
• Direct contracting team handling complex provider network strategies and bargaining for contracts.
• Coordinate with internal stakeholders to allocate resources (FTEs, technology) for strategic initiatives.
• Develop feasibility models and forecasting to assess contracting strategies and medical expense targets.

Skills

People leadership

Team management

Contract negotiations

Health plan experience

Financial modeling

Provider contracting

Cross-functional collaboration

Education

Bachelor's degree or equivalent

Job description

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

$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

About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at [e-mail].

Hybrid Flex

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.