Network Executive at Horizon Blue Cross Blue Shield of New Jersey in Hopewell, New Jersey

Job Description:

Job Summary:

This position is accountable for end-to-end ownership of the relationship with all network physicians within a Specialty function. This includes management of the Provider Network Specialists, the education, stability, quality, and effectiveness of existing physician network membership, and the strategy/planning around the acquisition of additional physicians into the network. This position will have overall responsibility for the administration and servicing of all physicians statewide.

Responsibilities:

* Drives network strategy of providers as it relates to his/her assigned Specialty. This consists of either direct control or dotted line accountability over all activities that grow and maintain provider network relationships or agreements by developing, leading, and implementing appropriate strategies. Leads the development and implementation of segmented or tiered relationship strategies that involve an end-to-end provider perspective. Participates in planning sessions with divisional leadership to look at integrated network strategy, including but not limited to, out-of-network strategy, pricing model review, policy development, survey analysis, customer differentiation strategies, and regulatory implementation planning.

* Partners with Risk Adjustment teams in achieving organizational goals relative to these initiatives.

* Analyzes key Horizon initiatives (MCR, delegated vendor arrangements, privileging, etc), determines the effect they will have on the provider relationship, and manages all communication around these changes as well as presents action plans to address related challenges. Will frequently interact on behalf of provider network with delegated vendor. Reports to leadership any potential problems or critical issues interfering with conservation, growth, or quality.

* Collaborates cross functionally with Value Based and Strategy teams.

* Assesses needs and plans for the acquisition of providers as it relates to his/her assigned Specialty and Primary Care Providers. Analyzes membership and geographical access by Specialty to determine specific goals and action plans for acquisition of new physicians, providing blueprint for physician contracting priorities. This includes driving strategy of new physician recruitment (both outreach and intake activities).

* Initiates and participates in contract renewals and ensures services are provided that will maximize the potential for retention and initial provider enrollment, including conducting cost-benefit analysis around each physician relationship and facilitation of access to contract negotiation team.

* Leads a team of 5-10 Provider Network Specialists. Accountable for the results of this cross-functional/divisional team from 4 or more departments of designated resources assigned to handle all aspects of Affiliation, Reimbursement, Education, and Inquiry Resolution for all physicians within Specialty. Executive sets standards and service level agreements, tracks and analyzes pod metrics to ensure goals and objectives are being met, and hold all team members accountable.

* Serves as internal-facing connection between the enterprise and the physician community. This includes gathering field intelligence to provide to internal Horizon decision-makers and driving policies by liaising with internal medical directors.

* Serves as external-facing connection between the enterprise and the physician community. This includes, consulting with physicians on issues and topics pertinent to them such as legislation, reform, any industry / company specific trends, and presents solutions for physician to manage these items. Develops and maintains relationships with physician practice owners, presidents of professional societies, and executives of organizations in the industry and in other target areas to maintain knowledge, etc. Informs and educates providers and physicians on Horizon-s products and services.

* Leads the transition to low cost self-service as an attractive alternative for the defined physician specialty, including but not limited to portal self-service and the use of Electronic Funds Transfer

* Serves as key partner to Horizon Healthcare Innovations organization (Pilot Leads) in all stages of pilot identification, launch, and monitoring. Paves the road for new arrangements by enhancing the existing relationship as well as providing -field intelligence- to shape / direct proposals for reimbursement arrangements. Network Executive will provide competitive intelligence around other company-s network strategies as well as internal information around actions already in play that Healthcare Services is pursuing with specific physician groups.

* Develops and monitors goals for staff and provides ongoing feedback and coaching. Conducts performance reviews on an annual basis and administers salaries for the staff. Directs the employment activities of the office that include staffing, development, and training.

* Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies, and procedures. Understands, monitors, and rectifies all compliance issues related to network physicians and their relationship with Horizon.

Knowledge:

* Comprehensive knowledge of healthcare industry, including operational knowledge, industry trends, legislation and compliance, and provider office practices.

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

Skills and Abilities / Functional Competencies:

* Executive Presence:

o Exhibits confidence and professionalism, communicates effectively at senior levels and interacts comfortably with medical professionals.

o Listens actively, speaks and writes clearly and engages in productive dialog. Demonstrates an appreciation for diverse points of view and incorporates them into one-s thinking. Conveys clear messages to a variety of listeners, addressing purpose, goals, issues and accomplishments.

* Relationship Building:

o Cultivates executive and provider relationships.

o Develops and maintains senior level external and internal relationships and participates in policy, practice and product decision making. Actively manages multiple provider accounts, engaging appropriate individuals to meet member needs and optimize end-to-end process performance. Seeks provider input while setting realistic expectations. Operates across organizational boundaries while respecting and leveraging local priorities, practices, systems and cultures.

* Informing and Influencing:

o Acts as `Voice of the Provider-.

o Advocates provider-friendly solutions to business problems and seeks provider input to proposed innovation, always looking to assure a positive provider and member experience. Speaks up when Horizon demands outpace the ability of providers to execute. Identifies and engages stakeholders, structures decisions and actions and holds individuals accountable for driving results.

* Negotiation and Issue Resolution:

o Surfaces and addresses tough issues.

o Brings difficult problems to the attention of relevant players and negotiates win-win, or at least buy-in, in situations where there are opposing viewpoints.

* Business Acumen: Understands the up-to-date industry landscape.

o Follows the top strategic, business, technical and physician specialty trends, both short and long term; anticipates and communicates business implications. Familiar with financial variables at the industry, provider and payer levels with particular insights into the financial model of physician practices. Converts market insights into practical plans of action.

* Analytics, Insights and Problem Solving: Approaches problems through data and experience, and serves as a catalyst for change, leading the search for better ways of working.

o Frames problems to reveal patterns, isolate root causes and generate practical solutions. Guides and participates in discovery, analysis and thoughtful identification of solutions. Understands the division of activities across functional lines, and how process and system integration can improve performance and enhance provider experience. Helps implement change across organizational boundaries, as required to improve the provider experience, using multiple levers related to people, process and technology.

* Teamwork and Process Thinking:

o Aligns Horizon demand with provider capacity to deliver.

o Collaborates closely with peers on other teams, and in other departments. Introduces the end-to-end perspective, with members and providers as `customers-, into product and project planning, design and delivery. Takes a cross-functional, integrated view of provider services and articulates future state work flows including inputs, work flow, resources, outputs and measures. Anticipates and resolves potential issues to avoid downstream problems and optimize the provider experience.

* Decision Making and Results:

o Balances competing objectives and works through to timely, effective decisions & actions.

o Identifies and addresses competing objectives through communication, engagement and issue resolution. Sets up performance scorecards based on appropriate measures to establish baselines, set targets and track progress. Follows decisions through to results.

Education:

* Requires a bachelor's degree in a related field. Prefers a master's degree.

Experience:

* Requires a minimum of ten (10) years of experience in Provider Relationship Management, Contracting, or Sales/Account Management within the Healthcare Industry. Proven track record of interacting with clinical professionals.

* Requires minimum five (5) years people management experience, preferably in the healthcare industry.

Travel (If Applicable):

* Travel throughout NJ required on a regular basis.

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.

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