Teams at Horizon Blue Cross Blue Shield of New Jersey

Lead development, negotiation, management, and implementation of provider contracts for hospitals, physician groups, and ancillary providers across fee-for-service and value-based payment models. Oversee contract loading, network adequacy, rate proposals, regulatory compliance, cost analyses, team leadership, vendor/stakeholder collaboration, and drive initiatives to reduce medical cost and improve network performance.

Leads risk adjustment operations by coordinating analytics, reporting, process improvement, and alignment across business units. Manages operational status tracking, presentations, special projects, issue resolution, and implementation of solutions related to product development, network design, and pricing. Provides actionable insights to leadership and manages, develops, trains, and evaluates staff.

Performs behavioral health utilization and care management, assessing medical necessity, coordinating services across providers and care settings, monitoring outcomes, advocating for members, documenting care, and supporting quality improvement. The role requires collaboration with patients, families, physicians, hospitals, and multidisciplinary teams to ensure appropriate, cost-effective care throughout the continuum.