Job Description

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary: Managing execution and delivery of designed experiences and provider account management across multi-disciplinary teams working with the network providers. Focus on key objectives of improving provider experience, collaboration, member affordability, and care delivery transformation and outcomes. Develop and grow positive, long-term relationships with physicians, healthcare systems and all other network providers to support and improve financial and quality performance within the contracted working relationship.

Lead a team that will redefine and own the provider experience, including processes for serving provider needs, engaging other Horizon teams, measuring provider experience, creating and distributing provider communications, and training and onboarding providers.

Responsibilities:

Provider Experience Design and Management:

Accountable for multi-stakeholder engagement and alignment from across the enterprise towards advancing the provider partnership strategy and its implementation.

Design industry leading \xe2\x80\x9cOne Horizon\xe2\x80\x9d provider experience strategy and communication vision, customized to key provider partnership types.

Drive market differentiation for Horizon and advances Horizon\xe2\x80\x99s healthcare value strategy by continual innovation in provider partnerships including growth in value-based partnerships and an integrated provider ecosystem.

Oversee measurement tracking, reporting, and analysis of provider experience to derive meaningful insights and inform process improvement.

Provider Relationship Management:

Develops and presents executive-level business cases to vet and support new program capabilities, models, provider participation, and strategic opportunities to advance the enterprise healthcare value strategy.

Represent the scope of the health plan/provider relationship across all areas as they relate to provider performance, market growth, provider experience, and operational excellence.

Provide strategic direction on contract renewals and alternative payment model performance management (value-based care).

Negotiates and resolves partner issues escalated by provider account executives or network contractors; develops and socializes approaches to resolving broader partner issues.

Build and maintain positive, trusting, and productive relationships with in-network providers at all levels, including C-suite executive leadership.

Build and lead a team of highly trained provider account executives to provide exceptional customer service to all providers to ensure satisfaction, retention, and Horizon\xe2\x80\x99s strong community reputation.

Lead and collaborate on identification, design, and implementation of new technologies and operational improvement opportunities to make the provider partnerships work more effectively and efficiently.

Lead meetings to review cross-functional strategies to improve the provider experience.

Collaborate with all internal Horizon teams and maintain a strong understanding of Horizon operations and processes, including contracting, provider data management, claims, and service operations.

Provider Education and Onboarding:

Own network education for new and retained providers including material development, education delivery, and engagement tracking.

Ensure new providers receive necessary onboarding information in a timely manner across all lines of business and provider-relevant functional areas.

Understand provider engagement with educational activities, determine when intervention is needed.

Network Provider Communications:

Lead creation and dissemination of communications to providers related to network operations, including information on policies and procedures, product iterations, compliance, and digital tools (e.g., Navinet, Availity) as well as other critical provider relevant changes in the areas of medical policies, case management/ utilization management, Medical Cost Action Plans (MCAPs), Horizon vendors, new provider interfacing technologies, and other key priority areas.

Collaborate with Corporate Communications and the Marketing / Branding teams to ensure provider communications are effective, timely, accurate, and compliant.

Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Education/Experience:

High School Diploma/GED required.

Bachelor degree in business, finance, accounting, health administration or any other related field preferred or relevant experience in lieu of degree.

Requires a minimum of 15 years of experience in complex environments within healthcare, healthcare consulting or managed care in a leadership role.

Requires a minimum of 15 years\xe2\x80\x99 experience in healthcare operations, contracting, value-based programs, and/or service delivery.

Requires a minimum of 10 years\xe2\x80\x99 experience in provider/ payer negotiations and/or partnership implementation and healthcare innovation.

Requires a minimum of 10 years management and supervisory experience.

Requires a minimum of 10 years demonstrated relationship management (internal/external and c suite) and development skills.

Requires a minimum of 5 years prior provider experience in population health and practice transformation.

Requires a minimum of 5 years prior value based quality measurement experience.

Requires a minimum of 5 years\xe2\x80\x99 experience in health care cost data review and interpretation and technical document writing.

Skills and Abilities:

Demonstrates ability to create, develop, and maintain business relationships in the Provider space.

Proven ability to exercise sound judgment.

Proven ability to ask probing questions and obtain thorough and relevant information.

Must be detail oriented with strong organizational skills.

Proven ability to follow detailed instructions is essential, along with proven problem solving skills.

Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.

Must demonstrate the ability to effectively present information and respond to questions from groups of providers, managers, clients, customers.

Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.

Demonstrated ability to deliver highly technical information to less technical individuals.

Able to interact and create positive working relationships with all levels of internal and external constituents and staff.

Willingness to work closely with in-house counsel as well as outside counsel to complete agreements.

Requires an attention to details, contractual and quality monitoring details often prescribed through law or credentialing organizations.

Knowledge:

Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications.

Requires knowledge of Health Care contracting.

Requires knowledge of health care industry or health insurance industry trends and market innovation.

Requires knowledge of the hospital and physician communities in the state of New Jersey.

Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice.

Requires knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital and physician practice.

Travel:

Moderate travel up to 50% required to provider locations.

Salary Range: $162,000 - $225,330

\xe2\x80\x8bThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Horizon Blue Cross Blue Shield of New Jersey