Senior Vice President, Care Integration & Management
Working with the CEO, lead the implementation and execution of an industry-leading network management strategy that promotes high-quality, cost-effective care and employs, among other things, innovative payment arrangements. Work collaboratively with other senior leaders to develop provider network(s) that competitively position BCBSRI in its local market. Drive healthcare affordability by partnering with providers to transform the delivery system while advancing quality of care, utilization management, pharmacy operations and clinical initiatives, which are aligned with the organization's strategy.
ESSENTIAL JOB FUNCTIONS:
- Provide strategic leadership for the organization and actively participate in the development of a network management strategy that includes all aspects of care integration for population health and provider network functions.
- Develop and implement innovative reimbursement models with all types of providers, including systems of care, which move away from fee-for-service payments.
- Drive plans to incentivize provider participation in integrated systems of care.
- Translate data analysis into actionable and measureable programs to influence medical cost trends.
- Work collaboratively with other parts of the organization to ensure development of provider networks that support BCBSRI products, while ensuring compliance with state and federal laws and regulations, as well as Blue Cross Blue Shield Association mandates.
- Advance the development and implementation of optimized care models and clinical programming to improve health outcomes for members and achieve targeted financial and clinical objectives.
- Ensure optimization of the claims payment cycle through oversight of reimbursement operations, system configuration, claims processing and payment controls functions.
- Establish collaborative, cross-functional teams with other parts of the enterprise to drive change.
- Build strong business relationships with provider network, including, but not limited to, physicians, hospitals and pharmacies.
- Lead improvements in accessibility by breaking down complexities, which results in a deeper understanding for our members.
- Oversee the budget and overall performance metrics for functions.