Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
About the Role
This position is responsible for implementing various initiatives that cross department lines in support of HCM's strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for ensuring compliance with accrediting, state and federal guidelines as well as divisional compliance.
What You'll Do
Research, coordinate and oversee development and implementation of special projects, studies and reports to satisfy information demands of management or various accreditation and regulatory requirements.
Ensure network compliance and consistency by identifying and correcting deficiencies relating to network compliance and/or network consistency.
Support and implement accreditation, regulatory and compliance activities, i.e. NCQA, URAC, CMS, physician contracts, site visit activities, etc.
Develop, implement and drive Action Plans to improve CAHPS and HEDIS scores.
Develop, implement and monitor policies, procedures, workflows and process improvements related to the department.
Interface with Market Business Units on new product implementations and projects; i.e., Product Rationalization and Health Care Reform.
Develop, coordinate and disseminate physician communications.
Develop and coordinate education documents for internal and external audiences.
Represents department at workgroup meetings and facilitates cross-functional teams to implement various network initiatives.
Facilitates cross-functional teams to implement various network initiatives.
Create and develop materials for seminars; this includes interacting with leadership of other divisions and contracting and negotiating with outside organizations and vendors.
Develop and drive Action Plans to improve Office Manager satisfaction scores.
Develop responses to RFIs and RFPs regarding Horizon's physician network, contracting standards and processes and ensure timely and accurate responses to the Proposal Department.
What You Bring
Education/Experience:
Require a Bachelor's degree from an accredited college or university with a major in business healthcare administration, finance, marketing or communications or comparable business experience.
Requires 3-5 years experience in provider relations.
Prior sales or marketing experience preferred.
Additional licensing, certifications, registrations:
Knowledge:
Require solid understanding of managed care principles, including capitation and PPOs.
Require knowledge of healthcare industry
Prefer knowledge of provider contracting
Prefer knowledge of State and Federal healthcare regulations
Prefer knowledge of major competitors
Skills and Abilities:
Requires excellent written and verbal communication skills and excellent presentation skills.
Requires the ability to work independently, set priorities and manage time effectively.
Requires extensive PC skills, preferably with Microsoft Access, Lotus Notes, Microsoft Word and Excel or comparable software.
Requires analytical skills necessary to evaluate trends, make recommendations and explain data.
Requires problem-solving skills necessary to identify and resolve member or provider complaints or concerns.
Prefers negotiation skills.
Travel (If Applicable):
Why Horizon?
At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!
Salary Range:
$79,100 - $105,945
This 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:
Disclaimer:
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
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.
