Actuary

Mgr, Network & Physician Contracting

Lead/support the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospital, and ancillary facilities across the payment spectrum.
Work with the Director on the fee-for-service (FFS) and value-based payment contracting initiatives, collaborating with payment evolution team to introduce the appropriate updated payment models (whether FFS or value based) and provider experience team to meet provider expectations. Lead/support complex negotiations and/or contracting arrangements which require developing a sound business strategy for the financial and legal terms required for contracting initiatives.
Responsible to work with Medical Economics and Actuary Department to draft provider rate proposals that adhere to Horizon’s unit cost trends and negotiate such proposals with hospital executives, physicians and ancillary providers directly.
Manage all the regulatory, accreditation and enterprise network adequacy requirements to ensure Horizon’s 3.7 million members have access to a broad network across all its lines of business. The manager will perform quarterly analyses of the provider network from a cost, coverage and growth perspective. Provide leadership in evaluating opportunities to expand or modify the network to meet the Enterprise goals.
Manages budgeting and forecasting initiatives for product lines to network costs and provider contracts.
Contributes to drafting hospital, professional and ancillary contract terms to ensure they conform with all regulatory, accreditation and enterprise requirements while advancing Horizon’s strategic and business objectives
This manager should have a demonstrated track record of creating and developing and managing successful network contracting strategies, with experience negotiating contracts with healthcare providers. This manager will lead a team of specialists, and independent contributors. Excellent communication and leadership skills are needed as this manager will work with a range of stakeholders both internally and externally.
This position will manage negotiations and contracting with all providers for all payment arrangements, including value-based primary and specialty programs. This team will also negotiate, execute, renew contracts for all providers and all payment arrangements. They will maintain contract standards and policies. They must collaborate with payment strategy team on contracting parameters and provider experience team on relationships. Finally, they must recruit and contract out-of-network providers.

*The ideal candidate is one who may have managed care and hospital side contracting experience with current leadership expertise.

We are a leading healthcare organization headquartered in New Jersey, managing a growing portfolio of healthcare properties and facilities throughout the state. As our footprint continues to expand, we are committed to strengthening enterprise-wide safety, resilience, and operational continuity.
In support of this growth, we are actively developing and enhancing advanced crisis management programs designed to protect our patients, employees, providers, visitors, and physical assets. These programs are structured to ensure rapid response, coordinated decision-making, and regulatory compliance across all locations during emergencies, disruptions, or high-impact events.
Our approach emphasizes preparedness, communication, and recovery—leveraging industry best practices, healthcare-specific risk mitigation, and continuous improvement to ensure we are ready to respond to both expected and emerging threats.