Job Description
Responsible for the assessment, development, articulation, negotiation, implementation and management of enterprise and divisional innovative provider reimbursement initiatives to be implemented with core network providers. Support team efforts to ensure Blue Cross NC holds a leading provider network capability position in the provider network dimension.What You'll Do
Responsible for research, analysis, development, implementation and negotiation of innovative provider network strategies, including:
Value based, shared risk arrangements
Long-Term Strategic Contracting Initiatives
Reducing Cost of Care
Improving Quality of Care
Provider Incentive Programs
Contract Administration Improvements
Communicate with internal stakeholders regarding the assignment of resources (FTEs, Technology, etc.) necessary to successfully implement the strategic network initiatives.
Participate in select internal and external (BCBSA, vendors, etc.) discussions regarding network 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.
Support the development of next generation, innovative global provider network opportunities through inputs to strategy recommendations and facilitating effective use of Plan resources to administer approved strategies.
Provide analysis and inputs to feasibility models and forecasts of the performance impact of innovative contracting strategies.
May participate in provider negotiations in a support role.
Collaborate with internal stakeholders to ensure operational and administrative capabilities are established to implement contract and service strategies.
What You Need
Bachelor's degree or advanced degree (where required)
3+ years of experience in related field.
In lieu of degree, 5+ years of experience in related field.
What We're Looking For
Proven experience in healthcare network management or provider relations.
Familiarity with Medicaid, Medicare, D-SNP strongly preferred
Strong analytical abilities to evaluate the impact of innovative contracting strategies and provide insightful recommendations.
Excellent communication and negotiation skills to effectively collaborate with internal and external stakeholders.
Demonstrated ability to manage multiple projects and initiatives simultaneously.
Strong problem-solving skills to develop and implement effective provider network strategies.
Ability to work collaboratively in a team-oriented environment.
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
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