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Job Summary

This position is responsible for overseeing enterprise payment transformation efforts including payment strategies and model design, and alternative payment model implementation and end-to-end VBC administration (e.g., data, platforms, technology and operations). This role is also responsible for VBC strategy including design of new VBC models and enhancement of existing VBC models across all Lines of Business and States and National Network Strategy and Integration. Specific responsibilities include direction and expansion of Value Based Care provider contracting (ACOs/Primary Care suite, Specialty models and Hospital models); development, direction and management of competitive provider pricing models, medical economic opportunity analysis and Performance Based Reimbursement programs; assessment of new network VBC target opportunities and value propositions; VBC strategy design, governance and execution; and development, promotion and presentation of network advantages/strengths. This role is also responsible for VBC analytics, provider performance reporting and reporting platforms as well as all payment administration systems including data integration, payment platforms delivery and technical releases, year around operations, audit oversight, and issue resolution. These teams are responsible for over $2B+ in provider payments a year.

Job Responsibilities:

VBC Strategy Development, Model Creation & Governance

• Direct team accountable for development and support of payment strategies and model design, and alternative payment model implementation across all Lines of Business including:
  • Primary Care Payment Strategies and Payment Models;
  • Specialty Care Strategies and Payment Models;
  • Hospital Payment Transformation Strategies and Models;
  • Payment Model Design and Governance
  • Payment Integrity Solutions
• Develop and manage the provider contracting guidance, contracting language, provider targeting & contracting readiness
• Drive the impact of programs through medical economic analysis, program evaluation and contract performance and annual strategy update
• Oversee VBC analytics including provider reporting platforms and VBC provider performance reporting.

VBC Administration (Data, Platforms, Operations) & Provider Reporting

• Develop the strategy that will determine how we advance and administer our VBC services and technologies utilizing accurate data and platforms that enable network strategies and provider performance by operating with accuracy, auditability, and scale.
• Oversee cross-functional VBC platform, data and technology implementations and compliance by directing teams through planning, contracting, system deployments, testing, regulatory filings, provider data loads, and adherence to BCBSA, regulatory, and policy requirements.
• Lead VBC contract operations and network relationships by overseeing contract configuration, VBC payment operations, provider connectivity through data delivery, and optimization of operating model to achieve efficiency and accurate payments.
• Provide strategic and operational leadership by directing cross‑functional teams and people leaders, managing service levels and reporting, advancing administrative/financial/clinical capabilities, and delivering on divisional objectives through collaboration and execution.
• Oversee business data analytics services for VBC DCL and Enterprise Attribution including platform & delivery, operations & development and consulting & training that will lead to providing robust network analytics, analysis and insights to identify and enhance initiatives to improve the competitiveness of our networks and products
• Manage end-to-end provider reporting across multiple platforms to ensure actionable and accurate provider information on quality, cost, utilization and contract performance
• Review and approve annual operating plans and budgets for departments, vendors and sites under management, driving to greater admin efficiency and scale.

JOB REQUIREMENTS:

• Bachelor’s degree and 10 years managed care experience at the health plan level or hospital/health system level, including direct responsibility for strategic network and financial management operations OR Masters Degree and 8 years of experience in a combination of healthcare consulting and/or data insights and finance relating to healthcare information
• 7 years management experience
• Leadership skills to lead team and drive results by working across departments.
• Experience with complex managed care concepts in a matrix management environment.
• Experience developing solutions/systems to support network development activities and Value Based Care programs.
• Expertise and/or demonstrated experience with business intelligence tools; designing, reporting and delivering analytical solutions; data management and warehousing, and the strategic use of information.
• Experience with enterprise-wide project coordination, project management, facilitation, presentation, and leadership experience.
• Experience in implementing large, complex multi-functional business systems into operations
• Experience with project management involving multi-functional team members.
• Experience in interacting and influencing diverse interest groups including providers, regulators, other health plans, members and staff.
• Knowledge of State and Federal laws and regulations.
• Knowledge of network management trends and innovations
• Clear and concise verbal and written communication skills including interpersonal and presentation skills.
• Experience with the insurance environment including trends in philosophy, theory, and applications concerning all products and services.

*Please note: This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$161,500.00 - $299,700.00

Exact compensation may vary based on skills, experience, and location.