Strategic Provider Relations & Compliance

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a role focused on provider relations, regulatory and accreditation activities in a leadership-capable team. You will develop and oversee projects, ensure compliance with accrediting bodies, and support initiatives across departments to improve performance metrics.

The position emphasizes collaboration across business units, development of education materials for internal and external audiences, and driving plan improvements in CAHPS and

Qualifications

• Bachelor's degree as specified or comparable business experience.
• 3–5 years experience in provider relations.
• Sales or marketing experience preferred.
• Knowledge of managed care principles and healthcare regulations.

Responsibilities

• Research, coordinate and oversee development of special projects, studies and reports for management and regulatory requirements.
• Ensure network compliance and consistency by identifying and correcting deficiencies.
• Support accreditation, regulatory and compliance activities (NCQA, URAC, CMS).
• Develop and drive action plans to improve CAHPS and HEDIS scores.
• Interface with Market Business Units on product implementations and projects.

Skills

Communication skills

Presentation skills

Independent work

Time management

Analytical skills

Problem-solving

Negotiation skills

Education

Bachelor's degree in business/healthcare administration/finance/marketing/communications or equivalent

Tools

Microsoft Access

Lotus Notes

Microsoft Word

Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a role focused on provider relations, regulatory and accreditation activities in a leadership-capable team. You will develop and oversee projects, ensure compliance with accrediting bodies, and support initiatives across departments to improve performance metrics.

The position emphasizes collaboration across business units, development of education materials for internal and external audiences, and driving plan improvements in CAHPS and