Senior Manager, Provider Contracting

Blue Cross and Blue Shield of North Carolina•Durham, CA

2d•$130,560 - $208,896•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 healthcare providers. The role leads efforts to strengthen Blue Cross NC’s provider network capabilities and advance innovative provider network strategies. The position drives next-generation global provider network opportunities, recommends and gains approval for strategies, negotiates approved strategies into provider contracts, and ensures Plan resources are used effectively to administer them. It also coordinates with internal and external stakeholders, including BCBSA and vendors, and collaborates across the organization to provide the staffing and technology resources needed to implement strategic network initiatives. The team builds relationships and negotiates directly with key providers, develops feasibility models, forecasts contracting-strategy performance, and supports medical expense targets. Limited travel is required within North Carolina, and candidates must live in North Carolina. Onsite expectations are discussed during the interview process. The role follows either a Hybrid Flex or Remote Flex arrangement depending on the work and distance from the Durham headquarters. Hybrid Flex employees work in the office at least two days a week; Remote Flex employees work virtually with a few office visits each year.

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 various reimbursement models such as value-based 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.
Limited travel within North Carolina is required.

Nice To Haves

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

Responsibilities

Lead a team managing complex enterprise and divisional provider reimbursement initiatives, including assessment, development, negotiation, implementation, oversight, and relationship management.
Lead a contracting team that researches, analyzes, develops, implements, and negotiates innovative provider network strategies.
Drive next-generation provider network opportunities, recommend strategies, gain approvals, negotiate approved strategies into provider contracts, and ensure effective use of Plan resources.
Lead select internal and external discussions about network providers and strategies, ensuring Network Management input and promoting consistency within Blue Cross NC and, where feasible, among other Blues Plans.
Coordinate with internal stakeholders to ensure resources, including FTEs and technology, are assigned to implement strategic network initiatives.
Lead the development of collaborative relationships and direct negotiations with key providers, including academic medical centers and multispecialty professional providers.
Oversee development of feasibility models and forecasts of the performance impact of contracting strategies.
Develop strategy to ensure medical expense targets are met.