Strategic Network Contracting Lead

Hc; Town of Newark (WI); On-site; USD 87,000 - 119,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior professional to lead network provider negotiations and contract management across multiple lines of business, including Commercial, Medicare and Medicaid. The role collaborates with Medical Economics, Actuary and Legal to ensure compliant, value-based pricing and contract implementation.

The position requires 5+ years in hospital finance or managed care network development, strong analytical and negotiation skills, and proficiency

Qualifications

• Requires a minimum of 5 years business experience in hospital finance and/or managed care network development.
• Requires a minimum of 5 years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs.
• Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice.
• Proficient in Windows-based environment, including Word, Excel, PowerPoint.

Responsibilities

• Facilitate and lead network provider negotiations for Horizons medical lines of business across Commercial, Medicare, Medicaid, DSNP, MLTSS and Casualty services.
• Ensure accurate implementation of contracts and loading in systems; manage provider file maintenance and hospital implementations.
• Collaborate with Medical Economics and Actuary to prepare rate proposals for all lines of business.
• Maintain contract language/templates and ensure compatibility with core systems.
• Contribute to network contracting strategy and adoption of value-based contracting models.

Skills

Negotiations

Contract management

Analytical thinking

Communication

Stakeholder management

Problem solving

Attention to detail

Presentation skills

Education

Bachelor's degree in business/finance/health administration

Master’s degree in health or business

High School Diploma/GED

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior professional to lead network provider negotiations and contract management across multiple lines of business, including Commercial, Medicare and Medicaid. The role collaborates with Medical Economics, Actuary and Legal to ensure compliant, value-based pricing and contract implementation.

The position requires 5+ years in hospital finance or managed care network development, strong analytical and negotiation skills, and proficiency