Get To Know Us!
Florida Blue, a GuideWell Company is part of a family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care. We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!
What Will Be Your Purpose
Our Network Development Contractors negotiate contract terms and establish contractual relations with providers. This role supports the continued growth of value based and performance-based relationships within the delivery system.
This role is accountable for developing and executing the provider contracting and implementation strategy for a defined market and responsible for participating in the development of the network management strategy.
Important to Know
- Must reside in Sarasota, FL or surrounding area
- This role will require frequent for company meetings and events
- Must have valid state Driver’s License
What You Will Be Doing
- Negotiate contract terms and establish contractual relationships with providers with moderate complexity
- Coordinate the implementation of contractual arrangements with internal business partners
- Establish and maintain business relationships with assigned providers that promotes positive provider engagement and enables achieving business objectives
- Resolve issues involving contract disputes, audit, provider performance and compliance in accordance with company policies and procedures
- Assist with the design, development, management and/or implementation of provider network configurations to achieve business objectives
- Assess and analyze data to ascertain, financial and quality performance, and implement medical cost management initiatives as directed
- Monitor provider performance and implement corrective action, if applicable, to improve provider performance
- Perform site visits to address member complaints/potential quality issues, communicate, train providers on administrative policies, business processes, capabilities and initiatives
What You Must Have
- 5+ years related work experience developing and maintaining provider contracts and/or relationships, and negotiations
- Related Bachelor’s degree or additional related equivalent work experience
- Experience of provider payment programs and billing practices Experience of insurance products and network configurations
- Experience in issue resolution with ancillary and hospital based providers
- Experience interpreting analytical data
- Valid Driver License Frequent local travel with occasional overnight stays
What We Prefer
- Experience using BCBSF systems (Diamond, Provider Information Platform (PIP), Siebel)
- 3 or more years of experience negotiating standard and non-standard provider contracts Experience negotiating with third-party representatives, hospital-based provider organizations and or ancillary provider organizations
- Experience using the Network Management Simulation Tool (SIM) Medicare and Medicaid experience
- Established relationships or familiarity with local providers and market dynamics
General Physical Demands
- Exerting up to 10 pounds of force occasionally to move objects.
- Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, Short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan includes employer contribution and employer match;
- Paid time off, volunteer time off, and 11 holidays
- Additional voluntary benefits available; and a comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
Salary
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
- Targeted/Typical Annualized Hiring Range: $72,300 – $90,400
- Annualized Salary Range:$72,300 – $117,500
- Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.