Senior Manager, Provider Contracting

Blue Shield of North Carolina•Durham, NC

1d•Hybrid

About The Position

The Senior Manager, Provider Contracting manages a team responsible for assessing, developing, articulating, negotiating, implementing, overseeing, and managing complex enterprise and divisional provider reimbursement initiatives. These initiatives involve integrated healthcare delivery systems, hospital systems, and key independent providers. The role leads efforts to maintain Blue Cross NC’s leading provider network capabilities and develop innovative provider network strategies. The position requires limited travel within North Carolina, and candidates must live in North Carolina. Onsite expectations will be discussed during the interview process. The work arrangement may be Hybrid Flex, requiring at least two in-office days per week, or Remote Flex, involving a few office visits each year; the arrangement depends on the work and distance from the Durham headquarters. The listed base salary range is $130,560.00 to $208,896.00. The total rewards package includes an annual incentive bonus, 401(k) with employer match, paid time off, and competitive health benefits and wellness programs. Compensation decisions may reflect experience, training, specialized skills, licensure, certifications, and business and organizational needs.

Requirements

Bachelor’s or advanced degree where required; in lieu of a degree, 10+ years of experience.
8+ years of experience.
Executive-level provider relationship experience.
High-complexity provider contracting experience, including experience with various reimbursement models such as value and pay-for-performance models.
Demonstrated understanding of financial modeling and cost-of-care impacts.
Demonstrated experience working with cross-functional teams within a health plan.
Must live in North Carolina.

Nice To Haves

Prior people-leader experience, including leading teams of 5–10.
Experience managing contract dollars upwards of $5 billion.

Responsibilities

Lead team efforts to manage relationships and assess, develop, articulate, negotiate, implement, and oversee complex enterprise and divisional provider reimbursement initiatives.
Lead a contracting team in building relationships and researching, analyzing, developing, implementing, and negotiating innovative provider network strategies.
Drive and facilitate innovative global provider network opportunities; recommend strategies, gain approval for selected provider strategies, implement them through provider contract negotiations, and ensure effective use of Plan resources to administer approved strategies.
Lead selected internal and external discussions about network providers and strategies, ensuring Network Management has direct input and promoting consistency within Blue Cross NC and, where feasible, among other Blues Plans.
Coordinate with internal stakeholders to ensure the resources, including FTEs and technology, needed to implement strategic network initiatives are assigned.
Lead the development of collaborative relationships and direct negotiations with key providers, such as academic medical centers and multispecialty professional providers.
Oversee development of feasibility models and forecasts of the performance impact of contracting strategies.
Develop strategies to ensure medical expense targets are met.