Manager, Strategic Provider Support

What You'll Do

People Management

• Develop performance goals and track performance against established goals. Handle complex employee issues.

• Conduct random audits of teams work.

• Review audit results with staff and create performance improvement plans as necessary.

• Develop and implement training plans to ensure growth and development for staff.

• Develop staff provider relation skills and provider communication through formal and informal training, coaching, and feedback.

• Interpret and analyze complex data from staffing models and other sources to identify issues and make recommendations for effective solutions.

• Develop resource allocation strategies to meet changing business demands.

Stakeholder Engagement

• Represent BCBSNC in stakeholder meetings to address stakeholder inefficiencies and to ensure contractual compliance.

• Plan all on-site visits to stakeholders to educate on BCBSNC 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, procedures and systems as they relate to the way they conduct business with BCBSNC.

• Develop and maintain extensive knowledge of key stakeholders and/or regional territories.

• Leverage knowledge base to forward Enterprise relationships with stakeholders.

• Track stakeholder issues for root-cause analysis, escalation, and closure.

• Document issue resolution using issue resolution protocol.

• Comply with state, federal and BCBSA regulations governing stakeholders and suggests implementation of any product, process, or system modifications to ensure compliance.

• Identify opportunities to control medical expense and deploy action plans to accomplish stakeholder-specific or regional medical expense goals.

• Participate in negotiations with stakeholders as needed.

Project/Program and Operations Support

• Manage day-to-day consultative activities for a high-profile healthcare system.

• Participate in and support negotiations as needed.

• Assist in the analysis of all products, identify any deficiencies and make recommendations for improvement.

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

• Lead team of onsite coordinators in identifying, analyzing, and resolving complex operational issues impacting the healthcare system.

• Act as technical resource for the team providing assistance on system issues, work processes, and procedures.

• Represent the department on corporate projects that require independent, sound decision making and broad-based understanding of the effects on the department as a whole.

• Develop and recommend short- and long-term service objectives and methods, implement these methods when approved.

• Respond quickly and accurately to escalated issues from clients and customers. Review customer needs and delivery commitments and review with team members.

• Identify, analyze and resolve complex high dollar operational issues impacting the healthcare system they are responsible for or the members and groups that they serve. Use the appropriate Stakeholder Service Model to increase customer satisfaction and reduce administrative costs.

What You Bring

• Bachelor's degree or advanced degree (where required)

• 8+ years of experience in related field.

• In lieu of degree, 10+ years of experience in related field

• LEAN certification advanced within 12 months of hire.

Bonus Points

• Experience in provider interactions with institutional, professional and ancillary providers.

• Experience in claims, customer service, membership, enrollment or a call center environment.

• Experience managing a project

• Ability to interpret policy provisions

• Make sound and independent business decisions in high pressure situations

• Excellent interpersonal and relationship building skills

• Strong data analysis and problem-solving skills

• Knowledge of institutional and ancillary pricing, health care finance, hospital and ancillary payments

• Strong negotiation skills

• Ability to effectively manage multiple high priority and high-profile tasks/provider relationships

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

• Work-life balance, flexibility, and the autonomy to do great work.

• Medical, dental, and vision coverage along with numerous health and wellness programs.

• Parental leave and support plus adoption and surrogacy assistance.

• Career development programs and tuition reimbursement for continued education.

• 401k match including an annual company contribution