2019-9402 Mgr, BH Network (Open)
Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jerseys 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.
Manager, Behavioral Health Network Manager
This position is accountable for leading a team of network management staff and managing the Horizon behavioral health (BH) network of ancillary and professional providers supporting the Commercial, Medicare Advantage, and Medicaid lines of business. Position is accountable for strategy development for all aspects of the BH Network and ensuring the team executes accordingly. Responsibilities include, but are not limited to, network adequacy and provider recruitment and contracting, overall compliance with Medicaid BH network requirements, provider communications, establishing contractual relationships including rate negotiations, contract development and execution, ongoing contract management, routine and escalated complaint resolution, project initiative planning and execution, network training and education to promote cost effective quality practice patterns. This position is also accountable to ensure network compliance with regulatory, accreditation and internal policies and procedures. Role is accountable for ensuring plan compliance with State Medicaid contract requirements and value-based contracting.
Education/Experience:
High School Diploma/GED required.
Bachelor degree in business, finance or health administration preferred or relevant experience in lieu of degree.
Master's degree preferred.
10+ years behavioral health provider relationship management, contracting or sales/account management within Healthcare Industry.
5 years supervisory experience.
5 years Behavioral Health experience required.
Apply Now
Manager, Behavioral Health Network Manager
This position is accountable for leading a team of network management staff and managing the Horizon behavioral health (BH) network of ancillary and professional providers supporting the Commercial, Medicare Advantage, and Medicaid lines of business. Position is accountable for strategy development for all aspects of the BH Network and ensuring the team executes accordingly. Responsibilities include, but are not limited to, network adequacy and provider recruitment and contracting, overall compliance with Medicaid BH network requirements, provider communications, establishing contractual relationships including rate negotiations, contract development and execution, ongoing contract management, routine and escalated complaint resolution, project initiative planning and execution, network training and education to promote cost effective quality practice patterns. This position is also accountable to ensure network compliance with regulatory, accreditation and internal policies and procedures. Role is accountable for ensuring plan compliance with State Medicaid contract requirements and value-based contracting.
Education/Experience:
High School Diploma/GED required.
Bachelor degree in business, finance or health administration preferred or relevant experience in lieu of degree.
Master's degree preferred.
10+ years behavioral health provider relationship management, contracting or sales/account management within Healthcare Industry.
5 years supervisory experience.
5 years Behavioral Health experience required.
Apply Now