This position is responsible for directing all negotiations and execution of Illinois value-based care relationships for commercial and retail business and sustainability of the professional, ancillary and hospital networks and their positioning within our product portfolio across HMO and PPO. This includes development and management of models and access standards mandated by regulation or necessary to meet market demands, as well as shared and global risk models that further local market strategies. The role will balance network needs with the financial implications of contractual arrangements on Plan P&L with an eye toward meeting long term strategic objectives. Individual will lead a team responsible for direct relationship development, critical contract negotiations, internal cross-functional engagement to further external objectives in working with network providers and will serve as business owner for the implementation of major changes to models and/or networks. Leader must work with enterprise areas to ensure there is alignment with network strategies and the financial implications thereof and is responsible for directing needed analysis by Analytics Team of current and proposed arrangements to assess their impact on BCBSIL strategy and to evaluate and implement value based care performance metrics.
Bachelor degree and 5 years experience in health care, health insurance, or strategic consulting environment
Leadership skills with an emphasis on experience managing external stakeholders
Experience with strategic planning, financial and data analysis, and research
Working knowledge of various health insurance products.
Negotiation skills and/or experience negotiating provider agreements
Experience leading and mentoring staff.
Clear and concise verbal and written communication skills.
Experience with interacting successfully with senior management and staff across multiple departments.
Experience consistently meeting deadlines and working well under pressure.
Organizational skills, including ability to prioritize tasks.
Business acumen, problem solving skills and project/process integration skills.
PC proficiency including Word, Excel, PowerPoint and databases.
Experience developing and analyzing reports.
Team player and people oriented.
Ability and willingness to travel, including overnight stays.
PREFERRED JOB REQUIREMENTS:
MBA or MHA
Health care industry experience
Experience working with providers
* Affordable Care Act Knowledge
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Network Management / Provider Relations Job Type Full-Time Regular Location IL - Chicago