Managed Care Provider Relations Manager jobs in Newark, NJ

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Manage day-to-day activities of Network Education, Training and Provider Relations Communications team.
• Leads the development of educational materials customized to targeted providers, office managers and their staffs, etc.; ensure materials are created to support information retention (e.g., use plain language guidelines, consider learning styles).

• Coordinate and work with teams across Health and Network Solutions as well as other areas of Horizon for the development, review/approval & delivery of educational and training materials.

• Disseminate educational materials through appropriate channels.

• Maintain education curriculum and dissemination schedule.

• Collaborates closely with Subject Matter Experts in developing targeting strategies, analytical insights, and strategic guidance for delivering messaging & increasing provider engagement in key Horizon initiatives.

• Monitors and reports out to leadership regarding identified trends, concerns and opportunities found through provider contact. Engages with pertinent staff and managers to ensure that interdependencies between the departments, other projects and functional work are accurately identified and addressed, and provides status reports to management.

• Plans, organizes, and presents seminars, conventions, speeches, etc. to management, various physicians and other health care professionals, medical societies and internal groups. Assists in visits to provider practices to solicit feedback, provide assistance and participate in practice meetings as necessary.

• Initiates communication with other members of the Provider Experience team and representatives from appropriate areas to effectively troubleshoot complex inquiries in order to improve service quality.

• Plan and execute scheduled conferences, engage Horizon's subject matter expects as appropriate.

• Lead all onboarding activities and provide all necessary materials in a timely manner.

• Track provider engagement with educational and training activities and provider portal.

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

• Lead dissemination of communications to providers related to network operations, including information on policies and procedures, product iterations, compliance, and digital tools (e.g., Navinet, Availity). The Manager and team will contribute meaningfully to the creation of provider education materials.

• Collaborate with Corporate Communications and Marketing/Branding teams to ensure provider communications to providers are accurate, effective, timely, and compliant with all Horizon policies and state and federal regulations.

• Understand new mediums for presentations.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

• High School Diploma/GED required.

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

• Preferred Master's degree in health or business.

• Strongly prefer a background in corporate education and communications.

• Requires a minimum of 5 years relevant experience in healthcare communications and education.

• Requires a minimum of 5 years of experience facilitating presentations (plans, organizes, presents internally and externally).

• Prefers marketing or sales experience in the healthcare/insurance industry.

• Requires a minimum of 5 years experience in successfully leading cross-functional teams to achieve improvements.

• Requires a minimum of 2 years provider facing experience.

• Prefers 3 years of supervisory experience; acceptable alternatives include successful examples of leading and influencing colleagues or peers, leading a strategic project, significant experience in the functional roles on the team, and/or completing a leadership development program or certification.

• Demonstrates ability to create, develop, and maintain training materials.

• Proven ability to exercise sound judgment.

• Proven ability to ask probing questions and obtain thorough and relevant information.

• Must be detail oriented with strong organizational skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.

• Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.

• Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers.

• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.

• Demonstrated ability to deliver highly technical information to less technical individuals.

• Able to interact and create positive working relationships.

• Requires an attention to details, contractual and quality monitoring details often prescribed through law or credentialing organizations.

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

• Requires knowledge of Principals of Health Care contracting.

• Requires knowledge of health care industry or health insurance industry

• Requires knowledge of the hospital and physician communities in the state of New Jersey.

• Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice.

• Requires knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital and physician practice.

• Moderate travel up to 50% required.

• Travel to Provider site to various healthcare facilities in NJ, NY or PA.

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.