Mgr, SHBP Partner Management

Company: Horizon Blue Cross Blue Shield of New Jersey
Location: Newark
Posted on: January 26, 2023

Job Description:

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

Job Summary:
This position will oversee and coordinate various initiatives including and not limited to new plan designs, out of network Initiatives and new programs as requested by New Jersey State Treasury Department for the State Health Benefit Plan. The scope of responsibility is directly linked to growing and maintaining a $5 billion book of business. This includes monitoring all SHBP/SEHBP performance guarantees and cost of care targets.

• Manage implementation and oversight of vendor programs like Health Guide roadmap by providing program oversight, and chairs the cross divisional governance meetings with the stakeholders. Oversees vendor contract performance, including risk amounts, SLA adherence, compliance, etc.
• Manage department budget(s), tracks accounts payables and receivables for SHBP account
• Collect, monitor and report out recovery fees, performance and financial guarantees; calculate the amounts at risk, and ensure information is passed to State Treasury as well as internal departments like Finance, Controller etc.
• Collaborate with Analytics, Underwriting, Actuarial and other cross functional areas to deliver weekly, monthly and ad hoc report requests from State of NJ and its consultant Aon.
• Act as a key liaison between Horizon and the State through partnership implementation and post-implementation support and governance. Develops and maintains relationships with stakeholders to enhance credibility and reinforce presence in the marketplace.
• Manage performance of initiatives like Value Based, DPCMH etc. as assigned.
• Oversee implementation of new product designs, network changes etc. as assigned
• Informs and supports Director, SHBP, including assumption of additional duties as assigned.
• Hires, manages, develops and trains staff; develops and monitors goals; conducts annual performance reviews, and administers salaries for the staff.
  Education/Experience:
  
  • Bachelor's degree from an accredited college or university or relevant work experience in lieu of degree.
  • Requires a minimum of 8 years of experience, 10 years preferred in the health care industry with a proven record of positive client relationships.
  • Requires 5-7 years of Group Health insurance experience
  • Preferred minimum of two (2) years' experience in a supervisory capacity.
    
    Additional Licensing, Certifications, Registrations:
    
    • Additional licensing, certifications, registrations
    • Prefers a New Jersey Health Insurance License or equivalent designation preferred, but not required
    • Requires a valid New Jersey driver's license.
      
      Knowledge:
      
      • Requires understanding of insurance delivery systems and claims systems
      • Requires understanding of expense management tools and techniques
      • Requires understanding of financial reporting tools and requirements
      • Requires familiarity with coordinating compliance requirements between multiple organizations and divisions
      • Requires familiarity with and comfort learning new claims payment and reporting systems
      • Requires strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams and external stakeholders
      • Requires strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects simultaneously
      • Requires understanding of interdependencies between business, clinical and financial side of the health care delivery
      • Requires proficiency in the use of personal computers and in supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) and Lotus Notes
        
        Skills and Abilities:
        
        
        • Personal and professional attributes that are critical to successful performance for Officers, Directors, and Supervisor/ Managers:
        • Character, Communicate, Ownership, Customer Focus, Effective, Accountable, Develop, Learn
        • Additional skills and abilities: Influencing, Negotiation, Verbal and Written Communication, Financial Acumen
        • Change leader
        • Strategic
        • Detail-oriented
        • Ability to execute flawlessly
          
          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.

Keywords: Horizon Blue Cross Blue Shield of New Jersey, Newark , Mgr, SHBP Partner Management, Accounting, Auditing , Newark, New Jersey