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Sr Director Network Contracting & Management - Tampa/Southwest Florida

Company: Florida Blue
Location: Fort Myers
Posted on: November 13, 2020

Job Description:

At the direction of the VP, Network Development, this role participates in the pricing and the strategic development process of the network composition and design for the Florida Blue products in the Commercial and Government segments inclusive of value based pricing and innovative payment models; actively negotiates with senior level executives within provider groups, health systems and vendors; maintains daily operational responsibility for professionals that have accountability for contracting, servicing and performance management activities across all provider types; and must collaborate across the enterprise with the segments, legal, sales, medical operations, analytics, IT, finance, customer service, brand/strategy, human resources, and the GuideWell business units.

Job duties include but are not limited to:

Accountable for an annual medical cost budget of $3B - $5B and the development and execution of strategies yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces and affordable and predictable product for customers and business partners

Lead complex contract negotiations at an executive level with a variety of health care entities for Commercial and Medicare lines of business

Develop and implement network configurations and incentive-based models as appropriate to deliver on quality and efficient high performing networks to support business objectives for Medical Loss Ratios (MLR), growth and income results

Establish and maintain effective business relationships that can be leveraged to achieve business objectives

Oversee analysis of claim trend data and/or market information to drive conclusions to support contract negotiations and medical cost initiatives

Develop and execute provider engagement strategies/initiatives to enable the business goals

Maintain accountability of the financial performance of the individual markets and understand the impact to the entire network

Collaborate with leadership matrix partners in Sales, Medical, Analytics, Product, Segment and medical leadership in developing and implementing an effective market strategy to support medical cost improvement and profitable growth

Support market expansion and M&A activities by leading provider contract analysis related to due diligence

Oversee network development staff and solution advisors in the development and performance management of our networks. Recruit, motivate, retains, develop and lead a team of professionals to achieve target results

Maintains network accountability and compliance for national Blue Card program and employer billing

Identify and manage risks, resolve conflicts and remove barriers that impede the department's ability to achieve company goals and objectives

Job Requirements:

Related Bachelor's degree required or additional related equivalent work experience

10+ years related work experience or equivalent combination of transferable experience and education. Experience Details: Health care industry; experience in network management-related role handling complex network providers with accountability for results

5+ years' experience leading a successful team in contracting

5+ years' experience in developing, managing and implementing medical cost management initiatives

5+ years of management experience including responsibilities of hiring, training, assigning work and managing performance of staff

Expert level knowledge of provider reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, Performance Based Contracting, Bundle Payment and other payment programs

Excellent communication/presentation skills with both internal and external audiences Executive level verbal and written skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex reimbursement policy standards

Ability to develop and maintain C- level relationships with providers and Health Systems

Excellent analytic and financial skills, with keen understanding of impacts to markets

Demonstrated problem solving, project management, organizational skills, interpersonal skills, decision making, results oriented, and continuous quality improvement skills

Preferred:

Master's degree

Understanding of BCBSF claims payment systems

Product knowledge

Knowledge of the Florida market and delivery system; understanding of regional variances within the markets

We are an Equal Opportunity Employer/Protected Veteran/Disabled. Associated topics: chief marketing officer, demand, event, government, lead generation, major gift, policy, product market, social media, university relationship

Keywords: Florida Blue, Fort Myers , Sr Director Network Contracting & Management - Tampa/Southwest Florida, Executive , Fort Myers, Florida

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