Network Development Contractor - Miami, United States - Florida Blue

Description

What is your impact:
The Network Developer is accountable for developing and executing the provider contracting and implementation strategy for a defined market. The position will be responsible for participating in the development of the network management strategy which includes aspects of technology, product, utilization management, and value-based care/fee for service, membership growth, marketing, compliance, and member and provider experience.

What are your responsibilities:

• Negotiate contract terms and establish contractual relationships with providers with moderate complexity

• Coordinate the implementation of contractual arrangements with internal business partners

• Establish and maintain business relationships with assigned providers that promotes positive provider engagement and enables achieving business objectives

• Resolve issues involving contract disputes, audit, provider performance and compliance in accordance with company policies and procedures

• Assist with the design, development, management and/or implementation of provider network configurations to achieve business objectives

• Implement medical cost management initiatives as directed

• Monitor provider performance and implement corrective action, if applicable, to improve provider performance

• Assess and analyze data to ascertain, financial and quality performance

• External execution of operational initiatives: self- service tools, retail, projects

• Proactively communicates and trains provider on administrative policies, business processes, capabilities, and initiatives

• Perform site visits to address member complaints/potential quality issues

What is required:
5+ years related work experience. Experience Details: Experience developing and maintaining provider contracts and/or relationships
Related Bachelor's degree or additional related equivalent work experience
Experience of provider payment programs and billing practices
Experience of insurance products and network configurations
Experience in issue resolution with ancillary and hospital based providers
Experience interpreting analytical data
Valid Driver License Frequent local travel with occasional overnight stays

What is Preferred:
Experience using BCBSF systems (Diamond, Provider Information Platform (PIP), Siebel)
3 or more years of experience negotiating standard and non-standard provider contracts
Experience negotiating with third-party representatives, hospital-based provider organizations and or ancillary provider organizations
Experience using the Network Management Simulation Tool (SIM) Medicare and Medicaid experience

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;

• Income protection benefits: life insurance, Short- and long-term disability programs;

• Leave programs to support personal circumstances;

• Retirement Savings Plan includes employer contribution and employer match;

• Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days

• Additional voluntary benefits available; and

• A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $74,200 - $120,500
Typical Annualized Hiring Range: $74,200 - $92,700

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.