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Value Based Program Specialist at Horizon Blue Cross Blue Shield of New Jersey

Posted in Other 30+ days ago.

Type: Full Time
Location: Newark, New Jersey





Job Description:

Job Summary:In support of the company's launch of the OMNIA Alliance, this position will be a key support driving the successful implementation of our innovative provider agreements. By working closely with the Manager, Provider Partnerships, this position will help drive execution of key support deliverables, be a data SME, ensure project work plans are executed resulting with high-quality deliverables. This person will be expected to effectively participate within cross-functional teams internally and externally. This position will also serve as a key support between Horizon and our strategic provider partners through activities related to partnership implementation, post-implementation support, and governance. The person in the position will develop and maintain strong relationships with our OMNIA partners.

Responsibilities:
- Drives Network Strategy & Building - Understand dynamics within the primary zone value based program participation, specialist and ancillary opportunities, urgent care accessibility;
- Drive strategy to align providers in the primary zone with Alliance partners.
- Support project delivery and maintains superior relationships with various strategic partners, including health care providers, facilities and other health care stakeholders throughout New Jersey.
- Assists in identifying and mitigating risks within external partnerships; develops, recommends, socializes, and ensures implementation of appropriate contingency plans.
- Delivers high-quality, actionable performance results, while ensuring timely completion of partnership implementation deliverables.
- Performs data analyses, makes recommendations and develops content, training and education to support strategic relationships.
- Reviews and performs complex analyses as directed by senior management.
- Presents complex analytical concepts into simplified and understandable recommendations to internal and external partners, and ensures appropriate implementation, as necessary.
- Partners with manager in developing and effectively presenting core issues to senior audiences in support of strategic partner relationships.
- Develops, maintains and leverages strong, cross-functional working relationships within a matrix reporting structure (Legal, Finance, HR, MBU, Service, IT, provider partners, etc.)

Knowledge:
- Requires knowledge of the hospital and physician communities in the state of New Jersey.
- Requires knowledge of Principles of Health Care contracting.
- Requires knowledge of health care industry or health insurance industry.
- Requires knowledge of laws and regulations regulating insurance, HMO, hospital and physician practice.

Skills and Abilities:
- 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.
- Must be results-driven.
- Exhibits an energetic, inquisitive, positive approach to problem solving.
- Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
- Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
- Proven ability to exercise sound judgment and strong problem solving skills.
- Proven ability to ask probing questions and obtain thorough and relevant information.
- Proven analytical, research and problem solving skills a must.
- Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.
- Must demonstrate the ability to effectively present information and respond to questions in large and small group settings, and at all organizational levels.
- Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.
- Exhibits proven project management skills.

Education:
- Bachelor's Degree required, post graduate degree preferred.

Experience:
- Requires a minimum of 5 years' work experience with a minimum of 4 years in the healthcare industry.
- Requires a minimum of 2 years' experience analyzing health care quality, utilization and cost data.
- Requires a minimum of 3 years' demonstrated experience in managing large initiatives or projects.
- Requires a minimum of 2 years of managing hospitals and/or physician practices relationships.
- Requires demonstrated experience in successfully building, maintaining and supporting effective relationships within cross-functional teams to achieve partnership goals.

Travel % (If Applicable):
- Minimum travel required

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..


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