Director- Value Based Provider Contract

Premera Blue Cross   •  

Mountlake Terrace, WA

Industry: Healthcare


8 - 10 years

Posted 179 days ago

This job is no longer available.

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

As the Director of Value Based Provider Contracts, you will lead value based provider and contracting initiatives, programs, and projects to execute Premera's strategic direction, integrating with Provider Contracting, Sales, other cross-functional partners, and the Blue Cross Blue Shield Association (BCBSA). In this role, you will assess the benefits and risks across the value based project portfolio to recommend and execute on investments in programs and projects, driving cost management, value based care and other contracting initiatives. In addition, you will manage team and enterprise-level programs/projects, analyze complex data, and clearly articulate goals, status, issues and solutions to senior management.

What you’ll do

  • Determine the strategy for value based provider contracts and incentives, in partnership with Sales and Provider Contracting teams, participate in network development/product analysis, and implement strategy.
  • Monitor national and regional trends in the healthcare industry and value based provider arrangements to identify key business initiatives and programs to drive cost management, value based care and other contracting initiatives to support Premera’s market, product and provider strategy.
  • Ensure incentive based agreements and value based contracts conform to and incorporate market imperatives and quality programs (MIPS, MACRA, NCQA & HEDIS).
  • Partner with Sales and PS&S teams to set the strategy on value based contracts and other specific contract initiatives and then implements the strategy, and participate in network development/product analysis and makes recommendations. Collaborate with leaders to synthesize or integrate work plans and resources and comply with company governance and change control processes.
  • Provide management expertise to interact across business segments with leadership of other operating companies and MBS's. Develop strong working relationships with GMs to collaborate on overall business objectives.
  • Develop and manage a highly complex portfolio of programs/projects within a multiple year roadmap, from business case through implementation. Monitor process, progress and results to ensure assigned programs/projects deliver value to Premera through tangible benefits and measurable outcomes both financial and non-financial.
  • Execute operational the specific strategies designed to provide optimal results for total cost of care reduction, increase in quality and customer experience. Align work with MACRA or other value based designs that lead to providers wanting to be in our value based agreements.

What you’ll bring

  • Bachelor’s degree or four (4) years’ work experience. Ten (10) years healthcare experience which includes:
  • Five (5) years of health care management experience (Managed Care, HMO, and BCBS) in hospital, clinic or healthplan
  • Five (5) years of managing teams.Five (5) years leading complex projects
  • Three (3) years developing business strategies and business processes.
  • Demonstrated working knowledge and experience in riskcontracting, value based contracting MACRA.
  • Significant exposure and understanding in provider relations and contract negotiation, including hospital contracting and managed care riskcontracting.