Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Establish, maintain, and enhance statewide provider networks and contracts for BCBSAZ product lines and TriWest. Manages relationships with key health care professionals and facilities to improve BCBSAZ’s medical cost position, clinical outcomes, and overall competitiveness.

 

ESSENTIAL job functions AND RESPONSIBILITIES

NETWORK MANAGEMENT

  • Negotiate contracts with providers to achieve desired financial and relationship outcome.
  • Work closely with Analytics and Actuarial to ensure all financial modeling is accurate based on assumptions provided. Understand and interpret financial analysis and use in negotiating contracts.
  • Understand and utilize financial reimbursement methodologies that are value based and different from normal fee-for-service reimbursement methodologies, in order to align both provider and BCBSAZ interests.
  • Support Value Based Reimbursement strategy area by developing contracts to support value-based arrangements made and ensuring they can be administered. Also involved in operationalizing and implementing contract after signed.
  • Create linkages between Provider Contracting and Health Services to drive lower medical cost outcomes while maximizing provider and consumer engagement in improving health outcomes.
  • Understands basics of contract language law and is able to negotiate contract language terms and conditions.  
  • Identify ways to increase the value and competitiveness of BCBSAZ network assets.

OVERALL

  • Maintain effective working relationships to ensure teamwork in achieving corporate goals.
  • Coordinate activities between multiple divisions to achieve desired results.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.
 

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Skills / Requirements

REQUIRED QUALIFICATIONS

  1. Required Work Experience
    • 3 years of managed care contracting and provider network development experience either at a health plan or for a large provider.
  1. Required Education
    • Bachelor’s degree
  1. Required Licenses
    • N/A
  1. Required Certifications
    • N/A

 

PREFERRED QUALIFICATIONS

  1. Preferred Work Experience
    • 2 years of management experience
    • 5 years of managed care contracting and provider network development experience
    • 3 years of provider network strategy experience

 

  1. Preferred Education
    • Master’s degree in business administration, healthcare administration, public administration, or related field and/or JD degree.
  1. Preferred Licenses
    • N/A
  1. Preferred Certifications
    • N/A

REQUIRED COMPETENCIES

  1. Required Job Skills
    • Strong written and verbal communications.
    • Intermediate financial acumen, including the ability to interpret financial analysis.
    • Intermediate PC proficiency.
    • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
    • Intermediate skill in word processing, spreadsheet and database software.
    • Intermediate skill using departmental BCBSAZ and BCBSA software.
  1. Required Professional Competencies
  1. Required Leadership Experience and Competencies
    • High standard of performance while pursuing aggressive goals
    • Principled leadership and sound business ethics

 

 

 

PREFERRED COMPETENCIES

  1. Preferred Job Skills
    • N/A
  1. Preferred Professional Competencies
    • Experience and knowledge of the provider community in Arizona
  1. Preferred Leadership Experience and Competencies
    • N/A
 

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online