Strategic Focus Jobs in Raleigh, NC (NOW HIRING)

• Support and implement athree-yearplanrepresenting:

• Strategic focus areas within NM

• Clear,conciseand practical goals andobjectives

• Supporting metrics and tactical plans

• Supportthe development and promote the implementation of new provider payment models and reimbursement methodologies for managed care programs and products. Conducts financial and other quantitative analysis to ensure agreements are implemented efficiently and correctly.

• Analyzes the negotiated agreement to ensureimplementation and reimbursement is completed accurately.Assistsmanagement with analysis and prioritization of areas of implementation and predict with reasonable accuracy expected financial results.

• Support the development and make recommendations for effective formats for providing education and programs to the provider community.Mediums available include printed materials,verbaland written presentations, andweb basedformats.

• Responsible for managing a strategy to schedule, plan and visit specific network providers to:

• Present or reiterate the BCBSNC medical and/or administrative policies and procedures;

• Address provider inquiries and concerns

• Disseminate information

• Addressspecific "non-compliance" issues with BCBSNC agreements and coordinate the required corrective action.

• Support the development and execution of meaningful provider workshops and education events.

• Support the development and execution of methods to gauge provider satisfaction with education staff, materials, and processes.Analyze and execute improvement plans.

• Timely management of resolution of large-scale issues for key providers.Makes recommendations to BCBSNC leadership on process improvements to enhance provider partner relationships.

• Identify,analyzeand resolve complexhigh-dollaroperational issuesimpactingprofessional, hospital, ambulatory surgical center, and ancillary providers. Use theappropriate StakeholderService Model to increase provider satisfaction and reduce administrative costs.

• Identifyopportunities to control medicalexpensesand deploy action plans toaccomplishstakeholder-specific or regional medical expense goals.

• Represent BCBSNC in critical stakeholder meetings to address stakeholder administrative inefficiencies and to ensure contractual compliance.Participate in negotiations with stakeholders as needed.

• Assistin the analysis of all products,identifyanydeficiencies,and make recommendations for improvement.

• Provide analysis and feedback for technologies, trends, bestpracticesand service offerings to incorporate them into overall stakeholder business solutions.

• Plan all on-site visits to stakeholders toeducate onBCBSNC medical or administrative policies and procedures.Address stakeholder concerns and non-compliance contract/administrative issues.Coordinate the required corrective actions.

• Partner with assigned stakeholders to understand their processes,proceduresand systems as they relate to the way they conduct business with BCBSNC.

• Develop andmaintainextensive knowledge of key stakeholders and/or regional territories.Leverage knowledge base toforwardEnterprise relationships with stakeholders.

• Track stakeholder issues for root-cause analysis, escalation, and closure.Document issueresolution using issue resolution protocol.

• Comply withstate, federal and BCBSA regulations governing stakeholders andsuggestimplementation of any product,processorsystem modifications to ensure compliance.

WhatYou'llGet

• The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community

• Work-life balance, flexibility, and the autonomy to dogreat work

• Medical, dental, and vision coverage along withnumeroushealth and wellness programs

• Parental leave and support plus adoption and surrogacyassistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

• Learn more