Value-Based Network & Physician Contracting Lead

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 109,600 - 149,625; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager of Network Contracting to lead development and execution of our provider contracting strategy across hospital, professional, and ancillary services. You will drive value-based contracting initiatives and negotiate terms that support Horizon's financial and regulatory objectives.

The role requires strong leadership, cross-functional collaboration, and the ability to manage multi-line provider relationships while aligning with

Qualifications

• Must have a minimum of 5 years demonstrated business experience in hospital and provider group finance and/or managed care network development.
• Requires a minimum of 5 years in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APCs, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements.
• Requires a minimum of 5 years’ experience in successfully leading cross-functional teams to achieve improvements.
• Requires a minimum of 5 years prior provider experience in Commercial, Medicare, Medicaid, and Value Based Programs is required.
• Requires a minimum of 3 years’ experience in health care cost data analysis and technical document writing.
• Requires a minimum of 3 years supervisory experience and/or leading people by influence.

Responsibilities

• Manage the development and execution of the network contracting strategy, including methods to adopt value-based contracting for providers operating under fee-for-service models, minimize special arrangements, and align to enterprise affordability objectives.
• Manage and negotiate contracts in compliance with Horizon reimbursement standards, and other key controls.
• Assist and implement provider contracting policies and procedures that are consistent with industry best practices and regulatory requirements.
• Ensure accurate implementation of contracts and coordinate with other departments for reporting, file maintenance, and claims analytics.
• Lead the team to recruit and contract out-of-network providers and ensure contract templates meet regulatory requirements.

Skills

Relationship building

Analytical skills

Judgment

Questioning

Detail oriented

Flexibility

Presentation

Communication

Education

High School Diploma/GED

Bachelor degree in health or related field

Tools

MS Office

Windows OS

Intranet/Internet applications

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager of Network Contracting to lead development and execution of our provider contracting strategy across hospital, professional, and ancillary services. You will drive value-based contracting initiatives and negotiate terms that support Horizon's financial and regulatory objectives.

The role requires strong leadership, cross-functional collaboration, and the ability to manage multi-line provider relationships while aligning with