Get to know us!
Florida Blue, a GuideWell Company, has been providing insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million healthcare members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.
Let’s talk benefits!
When it comes to our benefits, we offer a total compensation package including competitive base pay, health insurance, 401(k), as well as work-life balance programs. We design our offerings to take care of you-to help you be your best at work and in life.
What you will do:
This role is accountable for developing and executing the provider contracting and implementation strategy for a defined market. The position will be responsible for participating in the development of the network management strategy which includes aspects of technology, product, utilization management, and value-based care/fee for service, membership growth, marketing, compliance, and member and provider experience.
Important to know:
Candidates must be in South Florida to meet and work with providers in this area as needed.
The essential functions listed represent the major duties of this role, additional duties may be assigned.
- 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
- Implement medical cost management initiatives as directed
- Monitor provider performance and implement corrective action, if applicable, to improve provider performance
- Assess and analyze data to ascertain, financial and quality performance
- External execution of operational initiatives: self- service tools, retail, projects
- Proactively communicates and trains provider on administrative policies, business processes, capabilities, and initiatives
- Perform site visits to address member complaints/potential quality issues
- Support professional organization relationship events
- Execute provider facing deliverables for key projects
What you will need:
Experience:
- 5+ years related work experience developing and maintaining provider contracts and/or relationships
- Experience with provider payment programs and billing practices
- Experience with insurance products and network configurations
- Excellent verbal and written communication skills
- Experience in issue resolution with ancillary and hospital-based providers
- Experience interpreting analytical data
- Valid Driver License -frequent local travel with occasional overnight stays
Preferred Qualifications:
- 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
Education:
- Related Bachelor’s degree or additional related equivalent work experience
When you become part of the GuideWell family, you help bring our mission to life by helping people and communities achieve better health.
General Physical Demands:
Sedentary work: 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.
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.
Annualized Salary Range: $72,300 – $117,500
Typical Annualized Hiring Range: $72,300 – $90,400
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.