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.
This position is accountable for contracting of behavioral health (BH) professional agreements including the design, development and maintenance of BH special arrangement contracts in support of overall provider strategy and network development needs. Includes unit-cost modeling, negotiations and implementation associated with newly executed or renewals for professional behavioral health agreements. Responsible for the ongoing financial impact analysis for the BH professional network.
Key Responsibilities
- Lead negotiations for behavioral health professional agreements, including the design, execution, and renewal of special arrangement contracts.
- Partner with the Director of Network Innovation and Network Executive to manage budgeting, reporting, and reconciliation of pay-for-performance incentives.
- Collaborate with physical health contracting specialists on behavioral health aspects of multi-specialty and hospital-based physician agreements.
- Analyze utilization trends and performance against service-level agreements, recommending adjustments to optimize contract terms.
- Evaluate potential special arrangements using unit-cost modeling by specialty, market composition, and clinical needs. Present findings and recommendations to leadership.
- Manage all aspects of contract proposals, from preparation and presentation to negotiation and execution.
- Maintain accurate documentation and approvals in SharePoint for all special arrangements.
- Monitor utilization and reimbursement trends, collaborating with network specialists and HCM supervisors to address requests.
- Support the evolution from fee-for-service models to value-based care within the behavioral health network.
- Develop recruitment strategies to reduce out-of-network spend and improve overall cost efficiency.
- Coordinate with analytics and medical economics teams to oversee unit cost reporting and annual budgeting for behavioral health professionals.
Education & Experience
- High School Diploma/GED required.
- Bachelor’s degree in Finance, Economics, Healthcare, Business, or related field preferred (or equivalent relevant experience in lieu of degree).
- Minimum 7 years of managed care experience, including direct involvement with provider incentive and risk-sharing programs.
- Minimum 5 years of contract development and negotiation experience.
- At least 3 years of Behavioral Health experience strongly preferred.
- Experience with provider and hospital contracting in the NY/NJ or New England markets preferred.
- Working knowledge of State and/or Federal healthcare programs required.
Knowledge, Skills & Abilities
- In-depth understanding of managed care philosophy, principles, and policies.
- Strong negotiation, presentation, and communication skills.
- Ability to think both analytically and creatively in problem-solving.
- Excellent organizational and interpersonal skills with the ability to motivate others.
- Proficiency in Excel strongly preferred.
Travel
- Primarily within New Jersey, with occasional travel across the tri-state area.
Salary Range:
$86,000 - $117,390
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:
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.
