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

Job Summary :

Lead and drive the innovative transformation of Horizon’s payment landscape to enable better affordability and quality of care while also contributing to improved member and provider experience.

This team will be focused on strategic work aimed at better aligning financial incentives and key network partnerships with behaviors that result in high provider network performance and improved engagement.

Create value by focusing resources, building knowledge, and instilling leadership needed to achieve the enterprise goal of growing value-based, alternative payment model arrangements that incentivize payment for better outcomes.

At the highest level, this team will define attribution and payment models, processes, and technologies.

Responsibilities :

Create the strategic framework and roadmap for Horizon’s payment model evolution and oversee implementation of the strategy across fee-for-service and value-based payment models.

Develop strategy and process for build / buy / partner decision-making tied to the goal of accelerating and optimizing payment evolution and scaling glide paths to risk.

Establish and lead a team built to drive payment model evolution with an emphasis on market research, provider engagement best practices, analytical rigor, testing and evaluation, operational efficiency, and improved performance on financial and clinical outcomes.

Establish payment models that drive value across Horizon’s lines of business and that take into account employed and independent network partners, different specialty types, and clinical condition categories.

Drive implementation of new and / or updated payment models and collaborate with operations, clinical, contracting, payment integrity and analytics teams to ensure program efficacy, transparency and reporting accuracy.

Oversee research initiatives that illuminate new payment model innovations relative to design, technology, and execution.

Lead evaluation and prioritization of existing and new value-based payment model programs to determine which programs to launch, scale or sunset with timing as a key component as well as to assess and address models with overlapping populations / spend for best approach.

Determine enterprise payment model evolution goals and report out to senior leadership on progress.

Establish a business case development framework for new and / or updated payment models with a focus on increasing return on investment from provider payments.

Collaborate with contracting and provider engagement teams to craft provider messaging for payment evolution to encourage buy-in, increased engagement, and high performance.

Oversee the creation of education materials and internal / external stakeholder training on payment evolution strategies.

Collaborate across departments to ensure that payment services are aligned with the needs of members and the organization.

Represent the organization at industry conferences, webinars and other events. Ensures that Horizon is well-positioned to identify and capitalize on emerging trends and opportunities in Horizon’s market.

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.

Education / Experience :

High School Diploma / GED required.

Bachelor degree in business, finance, accounting, health administration or any other related field preferred or relevant experience in lieu of degree.

Master’s degree in health or business related field preferred.

Requires a minimum of 10 years of experience in complex environments within healthcare, healthcare consulting or managed care in a leadership role.

Requires minimum 10 years relevant experience in the payor market with a focus on payor-provider partnership development and management

Requires minimum of 5 years provider experience via managed services organization (MSO) or direct employment / consultation with provider groups.

Demonstrated success in developing alternative payment model strategies and implementing within payor-provider partnerships.

Requires minimum of 8 years’ experience in health care cost data analysis and technical document writing.

Requires experience leading teams focused on value-oriented payment models.

Requires a minimum of 5 years management and supervisory experience.

Skills and Abilities :

Demonstrated track record of developing and managing successful payment model evolution strategies, with experience from relevant healthcare areas such as payor, MSO, or provider group leadership focused on payor-provider partnerships development and management.

Lead a team that may consist of managers, specialists, and independent contributors.

Excellent communication and leadership skills are needed as this director will work with a range of stakeholders both internally and externally.

Demonstrates ability to create, develop, and maintain business relationships.

Proven analytical, business case and product design skills a must.

Proven ability to influence internal and external stakeholders through change.

Proven ability to exercise sound judgment with a particular emphasis on prioritization and go / no-go decision-making.

Must be detail oriented with strong organizational skills.

Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.

Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers.

Must have excellent verbal and written communication skills and demonstrate the ability to work collaboratively within a team.

Demonstrated ability to deliver highly technical information to less technical individuals.

Able to interact and create positive working relationships with all levels of internal and external constituents and staff.

Willingness to work closely with in-house counsel as well as outside counsel to complete agreements.

Knowledge :

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 Lotus Notes;

Should be knowledgeable in the use of intranet and internet applications.

Requires knowledge of Principals of Health Care contracting.

Requires knowledge of alternative payment models including how to implement such models.

Requires knowledge of health care industry or health insurance industry.

Preferred knowledge of the hospital and physician communities in the state of New Jersey.

Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice.

Requires knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital and physician practice.

Travel :

Minimal travel required.

Salary Range : $165,200 - $229,845

$165,200 - $229,845

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.

Last updated : 2024-06-09