Dir, HNS & Provider Financial Management

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.

Responsibilities:

• Internally consults as a support to the Contracting function, both for Facility and Professional negotiations. Participate in external contract negotiations as needed/requested. Provide thought leadership in the area of both product rate allocations and service line rate allocations. Develop appropriate reconciliation models as needed.

• Primary HNS liaison to the Finance/Actuarial departments. Responsible for maintaining Enterprise Unit Price Model (EUPM) reporting (w/ inputs from Contracting), Vendor cost assumptions, Value based care budgets and accruals and Hospital performance plan (HPP) financial budgeting and planning.

• Accountable for MCAP reporting across multiple lines of business. Supports MCAP ideation and opportunity evaluation. Establishes department level MCAP savings targets and related performance reporting.

• Supports professional rate development process for Vanova, including specialty specific rate targets. Responsible for developing dynamic scoring model to account for both planned unit costs as well as anticipated mix impact and mitigation.

• Directs / owns the creation of the annual HNS FTE budget of ~ 1,500+ FTEs. Own and manage the bi-weekly open requisition approval process for all of HNS.

• Create and direct the maintenance of workforce management models that measure staffing needs and variance in transactional roles within HNS.

• In collaboration with the HNS Finance business partner, work with HNS-LT to ensure SG&A budgets are appropriately developed, reported upon and managed within pre-established targets.

• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Minimum 5 years people manager experience.

• Requires a minimum of 7 years prior experience with healthcare financing or healthcare delivery required and 10 years experience is preferred.

• Requires a minimum of 5 years experience in both facility and professional payment methodologies.

• Requires a minimum of 5 years demonstrated abilities and experience in strong strategic planning, analytical, problem solving and leadership skills. 7 years experience is preferred.

• Strong negotiation skills with the demonstrated ability to secure stakeholder agreement.

• Requires a minimum of 5 years experience in people or client/vendor manager experience.

• Prefers a minimum 5 years experience with workforce planning and headcount management.

Knowledge:

• Knowledge of all facets of healthcare delivery system and operations.

• Knowledge of Health Insurance technologies and best 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 Outlook; Should be knowledgeable in the use of intranet and internet applications.

Skills & Abilities:

• Requires ability to build strong inter- and intra-departmental relationships with senior leadership.

• Must have effective executive level verbal and written communication/presentation skills and demonstrate the ability to lead as well as to work well within a team.

• Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.

• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.

Additional licensing, certifications, registrations:

Travel % (If Applicable):

• Minimal travel is required.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

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:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

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.