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Blue Cross NC · 10 hours ago

Manager, Strategic Provider Support

United States

Full-time

Remote

Mid, Senior Level

$74K/yr - $118K/yr

8+ years exp

Blue Cross NC is seeking a dynamic leader to drive excellence in provider, member, and business partner interactions. The Manager of Strategic Provider Support will oversee strategic functions to ensure compliance with standards and empower team members to achieve peak performance while fostering collaborative relationships across the organization.

Financial ServicesHealth InsuranceInsurance

Comp. & Benefits

Responsibilities

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

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

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

Qualification

LEAN certificationData analysisNegotiation skillsHealthcare finance knowledgeProject managementCoachingPerformance improvementsCustomer satisfactionAction planningInterpersonal skillsRelationship buildingProblem solvingDecision making