At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression.
JOB SUMMARY :
Oversee and direct all hospital, physician, and ancillary contracting duties, assuring access to a stable and competitively priced network on behalf of BCBSRI customers. Develop strategies and specific plans to influence the cost (and in some cases, quality) of care across all providers, including, but not limited to unit cost containment, trend impact through pay-for-performance and global reimbursement methodologies. Design and negotiate network configurations that support BCBSRI customer and regulatory requirements for high-performing/tiered network products. Foster an inclusive environment where BCBSRI’s team of Network Contracting professionals is continuously developed and their abilities can be leveraged to design and execute business strategy consistent with divisional and corporate objectives. Support an already strong and dedicated Network Contracting team of professionals through creation of a positive, team-based culture.
ESSENTIAL JOB FUNCTIONS :
- Oversee the work of hospital, physician, and ancillary contracting strategy, execution and administration. Provide leadership and support to Network Contracting team members, including continuously enhancing employee development focus and opportunities as well as performance management discipline.
- In partnership with associates and management, develop corporate reimbursement strategy and execution plans.
- Drive and at times, assist in the establishment of provider pay-for-performance programs and policies.
- Identify and establish high-performing/tiered network configurations through negotiation and partnership with leadership across the organization.
- Design and implement metrics and a related cross-organizational management discipline that supports Network Contracting’s ability to track key performance indicators (leading and lagging) and take timely action when unintended variance occurs.
- Represent division and organization at various internal and external negotiations, meetings and committees. Advise, consult, and lead on contracting, reimbursement and strategies emanating through multi-department directives and work efforts, while maintaining respectful, high-functioning contractual relationships.
- In partnership with management, develop, maintain, and update corporate payment policies and administrative procedures relating to contracted providers and contracting activities.
- Collaborate in setting and directing the deliverables of the technical and analytical support for establishing contracting strategies, specific negotiations and for purposes of monitoring contract/network performance.
- Develop and ensure clear departmental objectives, related plans and roles/accountabilities within Network Contracting and beyond to support and execute on plans. This management discipline will be underscored by specific metrics of success as highlighted above.
- Perform other duties as assigned.
Minimum Education and Experience:
Preferred Education, Additional Qualifications and Experience:
- Bachelor’s degree in Business Administration, Health Administration or related field, or an equivalent combination of education and experience
- Ten or more years in a high level management position in the managed care/insurance administration field or hospital/finance administration
- Seven or more years management experience or experience leading a team
- Experience developing and negotiating pay-for-performance and global reimbursement methodologies
- Experience designing and negotiating network configurations that support BCBSRI customer and regulatory requirements for high-performing/tiered network products
- MBA, MHA or equivalent
- Experience working within both a provider delivery system and health insurance