Dir, HNS & Provider Financial Management

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

The role requires extensive interaction across multiple departments within HNS, Horizon and External stakeholders. The role serves as the primary internal interface between HNS and Finance in multiple capacities, including related to budgets, SG&A and Actuarial pricing inputs. This role will partner with senior leaders to provide strategic direction and thought leadership support for the Network Contracting department for both Facility and Professional negotiations. This position will also play a key role within the overall MCAP process which is key to Horizon profitability. Leading a staff which will drive value to Horizon through multiple channels.

Responsibilities:

• Internally consults as a support to the Contracting function, both for Facility and Professional negotiations. Participate in external contract negotiations as needed/requested. Provide thought leadership in the area of both product rate allocations and service line rate allocations. Develop appropriate reconciliation models as needed.

• Primary HNS liaison to the Finance/Actuarial departments. Responsible for maintaining Enterprise Unit Price Model (EUPM) reporting (w/ inputs from Contracting), Vendor cost assumptions, Value based care budgets and accruals and Hospital performance plan (HPP) financial budgeting and planning.

• Accountable for MCAP reporting across multiple lines of business. Supports MCAP ideation and opportunity evaluation. Establishes department level MCAP savings targets and related performance reporting.

• Supports professional rate development process for Vanova, including specialty specific rate targets. Responsible for developing dynamic scoring model to account for both planned unit costs as well as anticipated mix impact and mitigation.

• Directs / owns the creation of the annual HNS FTE budget of ~ 1,500+ FTEs. Own and manage the bi-weekly open requisition approval process for all of HNS. 

• Create and direct the maintenance of workforce management models that measure staffing needs and variance in transactional roles within HNS.

• In collaboration with the HNS Finance business partner, work with HNS-LT to ensure SG&A budgets are appropriately developed, reported upon and managed within pre-established targets.

• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Minimum 5 years people manager experience.

• Requires a minimum of 7 years prior experience with healthcare financing or healthcare delivery required and 10 years experience is preferred.

• Requires a minimum of 5 years experience in both facility and professional payment methodologies. 

• Requires a minimum of 5 years demonstrated abilities and experience in strong strategic planning, analytical, problem solving and leadership skills. 7 years experience is preferred. 

• Strong negotiation skills with the demonstrated ability to secure stakeholder agreement.

• Requires a minimum of 5 years experience in people or client/vendor manager experience.

• Prefers a minimum 5 years experience with workforce planning and headcount management. 

Knowledge:

• Knowledge of all facets of healthcare delivery system and operations.

• Knowledge of Health Insurance technologies and best practices.

• 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 Outlook; Should be knowledgeable in the use of intranet and internet applications.

Skills & Abilities:

• Requires ability