Blue Cross and Blue Shield of Nebraska

Affordability Program Manager - Hybrid

Blue Cross and Blue Shield of Nebraska • $80K — $100K *
Phoenix, AZ 85032Hybrid
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 5 years of experience in analytical, actuarial or business analysis role
  • 5 years of experience working for a healthcare organization or health insurer
  • Bachelor's Degree in general field of study
  • Preferred: 5 years of experience in analytical, actuarial or business analysis leadership role
  • Preferred: 7 years of experience working for a healthcare organization or health insurer
  • Preferred: Bachelor's Degree in Business, Healthcare, Mathematics, Economics, Finance or related field.

Responsibilities

  • Lead cost of care initiatives aimed at optimizing high-quality medical care costs
  • Partner with leadership to implement affordability initiatives across various domains
  • Analyze and interpret trends in segment utilization, advising on affordability challenges
  • Develop business cases for cost of care initiatives to guide leadership decisions
  • Advocate for customer needs in corporate committees and assure effective communication of actions
  • Monitor economic and healthcare issues affecting cost and utilization trends
  • Engage in meetings to ensure alignment with segment priorities and cost of care initiatives
  • Build relationships with internal and external stakeholders to support corporate goals
  • Drive performance through organizational planning and collaboration.

Benefits

  • Participation in strategic planning activities
  • Opportunities for collaboration across departments
  • Engagement in a customer-focused work environment
  • Onsite work schedule of 1 day per week with full-time commitment
  • Involvement in major decision-making processes affecting the organization.
Full Job Description
PURPOSE OF THE JOB
  • Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.


  • Manage Segment Affordability by partnering with Analytics to identify, analyze, interpret, and validate trends, advising Growth and Segment leadership team of affordability challenges and potential mitigating actions.


  • Partner with other Cost of Care Workstreams to identify and implement Affordability Initiatives (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)


REQUIRED QUALIFICATIONS

Required Work Experience
  • 5 years of experience in analytical, actuarial or business analysis role
  • 5 years of experience working for a healthcare organization / health insurer


Required Education
  • Bachelor's Degree in general field of study


Required Licenses
  • N/A


Required Certifications
  • N/A


PREFERRED QUALIFICATIONS

Preferred Work Experience
  • 5 years of experience in analytical, actuarial or business analysis leadership role
  • 7 years of experience working for a healthcare organization / health insurer


Preferred Education
  • Bachelor's Degree in Business, Healthcare, Mathematics, Economics, Finance or related field of study.


Preferred Licenses
  • N/A


Preferred Certifications
  • N/A


ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

PRODUCT AFFORDABILITY (COST OF CARE MANAGEMENT)
  • Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.
  • Partner with Workstream leadership to identify and implement Affordability Initiatives impacting the Segment (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)
  • Partner with Analytics to identify, analyze, interpret, and validate trends and patterns in Segment utilization across provider panels, care settings and other categories, advising segment leadership team of affordability challenges and potential mitigating actions.
  • Develop business cases related to Segment cost of care initiatives to support Leadership decision-making and prioritization of opportunities based on balancing organizational alignment, ROI and resource constraints.
  • Provide leadership and segment representation on corporate committees, advocating for customer needs and effectively communicating decisions and actions to segment leadership.
  • Monitor external economic and healthcare issues affecting cost and utilization trends impacting the industry, the organization, and the segment.


SEGMENT NETWORK DEVELOPMENT
  • Prepare fact-based analysis and strategic recommendations to drive development of new/modified provider networks, including potential impacts of provider risk sharing as appropriate.
  • Partner with Analytics and Provider Network teams to identify providers and locations practicing high value care for inclusion in current or future Exclusive Network offerings.
  • Lead segment in Value-Based Partnerships, ensuring appropriate information sharing and monitoring outcome metrics in order to drive improved segment affordability and pricing predictability.


OVERALL
  • Actively engage in Segment Departmental and General Manager meetings to ensure alignment with Segment Priorities and socialization of Cost of Care initiatives.
  • Build and maintain effective working relationships with internal stakeholders and key external contacts to ensure teamwork in achieving corporate goals.
  • Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.
  • Drive performance through management and execution of organizational plans and activities.
  • Coordinate activities between multiple divisions to achieve desired results.
  • The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.


REQUIRED COMPETENCIES

Required Job Skills
  • Intermediate PC proficiency
  • Intermediate proficiency with Microsoft Office, including Excel, Word and PowerPoint
  • Intermediate proficiency with Tableau or other data visualization tools.
  • Excellent presentation and communication skills
  • Strong research and organization skills


Required Professional Competencies
  • Advanced analytical and problem-solving skills necessary to generate insights and recommendations based on available data
  • Ability to recognize strategic opportunities and use data to make timely and sound decisions
  • Excellent professional and interpersonal skills, including the ability to collaborate with team members and business stakeholders at all levels of the organization
  • Advanced project management experience.
  • Flexibility and willingness to adjust to shifting demands/priorities.
  • Strong customer service skills.


Required Leadership Experience and Competencies
  • Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
  • Ability to maintain high standard of performance while pursuing aggressive goals
  • Ability to influence key stakeholders to accomplish key objectives
  • Ability to maintain confidentiality and privacy
  • Principled leadership and sound business ethics


PREFERRED COMPETENCIES

Preferred Job Skills
  • N/A


Preferred Professional Competencies
  • N/A


Preferred Leadership Experience and Competencies
  • N/A


Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

About Blue Cross and Blue Shield of Nebraska

Blue Cross and Blue Shield of Nebraska (BCBSNE) is a non-profit health insurance company headquartered in Omaha, Nebraska. The company provides health insurance coverage to individuals, families, and businesses in Nebraska. BCBSNE offers a variety of health insurance plans, including individual and family plans, Medicare supplement plans, and employer group plans. The company was founded in 1939 and has since grown to over 800 employees.
Learn more about Blue Cross and Blue Shield of Nebraska
Size
800 employees
Industry
Healthcare
Founded
1939
* Ladders Estimates

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