Job DescriptionYour Role The Payment Innovation team leads the strategy, design, development, and implementation of value-based payment models. The Director, Program and Project Management - Payment Innovation will report to the Senior Director of Payment Innovation. In this role you will be responsible for leading the strategy and end-to-end design of multiple new value-based payment models, leading the end-to-end program of multiple new and current payment models and the outcomes of those models that support Blue Shield's strategic goals. He/she/they will manage program(s) from initiation through delivery, perform operational responsibilities, and monitor for continuous improvement.
ResponsibilitiesYour Work In this role, you will:
- Oversee and lead the design and implement value-based payment models/payment mechanisms spanning across business areas where analysis requires evaluation of intangible variance factors.
- Lead contract writing, revisions, and tracking for value-based payment models
- Be the subject matter expert on Value Based payment, ACOs, OCHA value Based payment requirements, Learning and Action Network (LAN) Value Based Care criteria, CMMI models, and CMS strategies.
- Engage with all levels including senior management, make recommendations, and influence decision-making on alternative and value based payment model
- Lead and leverage cross-functional internal and external relationships to drive initiatives forward
- Lead a team to plan and implement complex projects/programs spanning across business areas
- Determine key business issues, develop effective action plans and implement to successful conclusion
- Lead the development of pay for value strategies and new products
- Lead cross functional project teams, including defining meeting agenda, lead meetings, capture meeting notes, and follow-up on action items
QualificationsYour Knowledge and Experience - Requires a bachelor's degree or equivalent experience
- Requires at least 10 years prior relevant experience, including 6 years of management experience
- Previous experience in value-based care design including designing value-based payment models or financial models is preferred
- Requires previous experience in designing a program/initiative end-to-end, including conceptual design, implementation planning and execution, and on-going operational support
- Requires contract writing experience or experience in drafting documents
- Required knowledge and experience of health insurance business and structure, preferably within a payor
- Requires experience with aligning disparate stakeholders and driving towards outcomes
- Requires experience with payor data infrastructure, regulations for various lines of business and contracting preferred
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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