Sr Mgr, Network Operations - Hybrid

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Arizona seeks a senior leader for Provider Network Management to coordinate Medicaid segment communications and maintain a healthy provider network. The role emphasizes staff leadership, contract compliance, and cross-department collaboration to resolve provider issues and drive performance.

The position requires a Bachelor’s in health care or related field and a valid AZ driver's license, with onsite requirements 2 days per week in Arizona.

Qualifications

• Minimum of three (3) years' experience working in network development.
• Bachelor's Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.
• Valid Arizona Driver's license required as travel is required.

Responsibilities

• Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.
• Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.
• Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.
• Routine, proactive, and meaningful interaction with internal departments to ensure contracts are implemented as intended.
• Represent administration at provider meetings (JOC Meetings).
• Achieve financial objectives.
• Communicate job expectations to staff.
• Plan, assign, monitor, and appraise employee’s job results.
• Develop, implement, and enforce policies and procedures.
• Maintain, train, orient, mentor, and evaluate staff.

Skills

Network operations

Provider relations

Team leadership

Staff management

Project management

Education

Bachelor's Degree in Health Care Administration/Business Administration/Finance/Economics/Accounting/Management

Master's Degree

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

Directly responsible for ensuring coordination of communications between the Medicaid Segment and the provider network, while maintaining a sufficient provider network through avenues such as provider satisfaction, continuous review of network adequacy, and provider demographic accuracy. Oversees Provider Services staff and ensures there is sufficient staff to enable providers to receive prompt resolution to their problems or inquiries and appropriate education about participation in the Medicaid Segment network.

REQUIRED QUALIFICATIONS

Required Work Experience

• Minimum of three (3) years' experience working in network development

Required Education

• Bachelor's Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.

Required Licenses

• Valid Arizona Driver's license required as travel is required.

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• N/A

Preferred Education

• Master's Degree

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.
• Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.
• Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.
• Routine, proactive, and meaningful interaction with internal departments, including, but not limited to Reimbursement Services, Clinical Operations, Prior Authorization and Member/Provider Services to ensure terms and/or provisions in executed contracts are implemented as intended.
• Represent administration at provider meetings (JOC Meetings).
• Achieve financial objectives.
• Communicate job expectations to staff.
• Plan, assign, monitor, and appraise employee’s job results.
• Develop, implement, and enforce policies and procedures.
• Maintain, train, orient, mentor, and evaluate staff.
• Ensure staff have tools needed to be successful.
• Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Medicaid Segment employee.
• Annual department budget is prepared timely and adhered to.
• Policies and procedures are updated annually (more often if necessary).
• Staff is maintained at an adequate level and receives appropriate training to perform job
• Staff have clearly defined and up-to-date job descriptions with specific goals and objectives.
• Employee issues (performance, behavior, compliance with policies, etc.) are addressed timely and appropriately in accordance with company policies.
• Valid Arizona Driver's license required as travel is required.
• The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

REQUIRED COMPETENCIES

Required Job Skills

• Experience with network operational systems and processes
• Experience leading development of proactive and effective provider relations
• Experience building and managing onsite and remote teams
• Track record of improving processes, teams, and performance
• Strategic and critical thinking skills
• Problem solving/analysis

• Strong Presentation Skills

Required Professional Competencies

• Experience collaborating with teams, vendors, and resources
• Independent decision-making abilities
• Results driven and client focused
• Initiative and proven organizational skills

• Proactive problem-solver focused on quality improvement
• Computer experience necessary
• Effective interpersonal and communication skills
• Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
• Ability to manage large workload
• Ability to maintain positive work relationships experience and knowledge of general health plan operations

Required Leadership Experience and Competencies

• N/A

PREFERRED COMPETENCIES

Preferred Job Skills

• N/A

Preferred Professional Competencies

• N/A

Preferred Leadership Experience and Competencies

• N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com.