Job Summary:

• Lead the development, analytics and presentations to senior management for all behavioral health unit pricing and provider reimbursement models, including value based care models, for all applicable NovaWell's clients.

• Develop and deliver MOR's for all NovaWell clients including Horizon BCBSNJ. This includes the ownership of identifying key variances to plan, as well as year-over-year trends, and delivering thoughtful and comprehensive analytics targeting root causes of such variances.

• In conjunction with the MOR's and the identification of variances and unfavorable trends, collaborate with the behavioral health team(s) on the ideation, development, sizing, implementation and ongoing evaluation of medical cost action plans (MCAP's).

• Accountable for the development and completion of the annual behavioral health cost of care budgeting and forecasting process, including level of care targets for utilization, unit cost and PMPM's, by line of business, for all applicable NovaWell contracts including Horizon BCBSNJ.

• Develop and drive NovaWell new business development support through associated prospective client analytics and opportunity analyses focused on showcasing NovaWell's value proposition and supporting the client's own economic business case.

• Lead and participate in NovaWell's new business development through the underwriting and pricing of NovaWell's products and solutions on a client-by-client basis. Continually improve and enhance the underwriting and pricing process and models based on lessons learned and collective feedback from business partners.

• Collaborate with Analytics and NovaWell Program Owners to regularly assess NovaWell's programs from a value proposition perspective through the use of pre and post program analytics and studies which would be utilized in NovaWell's business development activities.

• Accountable for the maintenance, refresh, update and enhancement of NovaWell's 10-year Financial Model including the associated financial slides presented to both NovaWell and Horizon senior management, as well as the Board of Directors.

• Support the development and construct of NovaWell contract P&L's, including membership, revenue, direct service costs, indirect costs and corporate overhead charges and allocations, in order to continuously asses the profitability of contracts and products as compared to initial underwriting.

• Support the development, implementation, continuous evaluation and validation of the associated charges and fees between NovaWell and Horizon related to the programs and, or services that each organization provides the other as documented within the Master Service Agreement (MSA) between the Parties. Ensure that all fees and charges between the Parties fully comply with the MSA and are adequately supported with details and documentation.

• Support the NovaWell and Horizon leadership teams develop and complete critical NovaWell annual business planning and forecasting deliverables which include, but are not limited to, revenue, performance guarantees, direct service costs (staffing and non-labor), indirect costs (NovaWell business unit - staffing and non-labor) and allocations (including direct charges).

• Collaborate with Horizon's Corporate Finance teams related to NovaWell's financial governance process to ensure the credibility of NovaWell's financial statements including Revenue, SG&A expenses, and cost allocations.

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.

• High School Diploma/GED required.

• Bachelor degree in Accounting, Finance, or Business preferred or relevant experience in lieu of degree.

• Master's degree in business administration, accounting or finance a plus.

• Requires a minimum of eight (8) years of progressively responsible experience with general accounting, financial analysis, financial modeling, budgeting and related functions preferably in the health insurance industry.

• Requires analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities).

• Requires work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.

• Requires strong problem solving and analytical skills; experience with relational database and techniques.

• Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.

• Requires demonstrated understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principles.

• Requires the ability to express thoughts clearly and concisely, both verbally and in writing.

• Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.

Salary Range:

This position is eligible for sales incentive compensation in addition to base pay. 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

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.