Director, Contract Development & Standards

BlueCross BlueShield of Tennessee is hiring a Director of Contract Development & Standards. In this leadership role within Provider Network Management, you'll set contract management and administration strategy as well as credentialing strategy (and oversee operations for both areas). Ideal candidates will come to us with expertise in accrediting and regulatory standards (NCQA, CMS, EQRO, Division of TennCare). Additionally, knowledge of Tennessee laws and regulations that govern the development and execution of provider contracts is critical; holding a Juris Doctorate is a plus.

Note: This role can be fully remote, but will require at least quarterly travel to our Chattanooga, TN headquarters.

Job Responsibilities

• Developing and maintaining appropriate external relationships (i.e. regulatory agencies and professional associations) in support of the network.
• Setting business goals and strategies for provider programs and services in alignment with organizational strategies.
• Establishing reimbursement policies, processes and associated monitoring systems for all professional network providers; developing incentive programs for providers.
• Directing the design, development, maintenance and servicing of all provider programs and contracts; ensuring integrity and adequacy of all managed and indemnity networks.
• Local travel may be required.

Job Qualifications

Education

• Bachelors Degree in Business Administration or related field

Experience

• 1 year - Direct experience in technical training and communication required
• 5 years - Experience in a leadership/management role required
• 5 years - Sales support, proposal management, legal, and/or contracting experience required
• 1 year - Understanding and working knowledge of contracting process flows

Skills/Certifications

• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical, planning, organizational and research skills
• Knowledge of Tennessee Insurance laws
• Knowledge of Tennessee laws and regulations that govern the development and execution of provider contracts
• Knowledge of accrediting and regulatory standards such as NCQA, CMS, EQRO and Bureau of Tenncare
• Knowledge of the BlueCross Association requirements that govern provider network operations and the BlueCross system.

Number of Openings Available:
1

Worker Type:
Employee

Company:
BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.