Provider Relations
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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:
• Bachelor's degree required or equivalent work experience
• 10+ years related work experience to include experience in network management-related role(s) handling complex network providers with accountability for results
• 5+ year minimum of management experience including responsibilities of hiring, training, assigning work and managing performance of staff
• Experience leading a successful team in contracting
• Experience developing, managing and implementing medical cost management initiatives
• 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

• Master’s degree
• 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.

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