CareFirst BlueCross BlueShield Jobs Hiring Now

Resp & Qualifications

PURPOSE:
Responsible for building and executing new collaborative relationships with health care delivery partners to advance and accelerate adoption of new payment models that align incentives more closely with value-based payment methodologies and further away from volume-based fee for service approaches. These collaborations are designed to create measurable value in health care and slow growth in health care cost over time. In addition, the executive is responsible for managing various regulatory and accreditation requirements in regard to adequacy and maintaining the competitiveness of the CareFirst providers networks using all available levers to drive development of access in specific geographies to ensure equitable access to healthcare. The incumbent drives the creation of value through a variety of existing and emerging contracting strategies which includes a mix of fee for service, population based, capitation, medical loss ratio and episode of care contracting approaches for all lines of business. We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

• Develop, execute and adjust a growth-oriented network roadmap and strategy designed to use CareFirst's health care spending to intentionally reshape the care delivery system in a way that promotes improved value, access, and outcomes for the community's investment in health care services. Considers the impact of regulatory framework on current and future plans and drives public policy agenda when appropriate to ensure the protection of CareFirst accounts. Ensures compliance with all existing and new regulations.
• Actively drives cost of care initiatives related to the provider network by contributing to cross-functional groups with specific affordability objectives. Develop, implement and maintain new and innovative payment methods to provider organizations to thoughtfully and efficiently finance the transition from a volume-based health care system to one that rewards value creation, and at the same time leads the strategic development and maintenance of the CareFirst base fee schedules and reimbursement methodologies and oversight to the analysis used in all FFS provider negotiations. Directs and controls departmental functions associated with the process of negotiation and maintenance of Professional, Ancillary, and Institutional contracts (including DC and VA hospital contracts) for all lines of business. This includes negotiating, financial analysis and quantification, networks impacts, qualification and competitive analysis and implementing all non-standard contracts. Responsible for the CareFirst provider agreement templates used to contract all providers in one or many networks. Identifies and implements opportunities to improve workflows, drive administrative efficiencies and leverage technology for better results.
• Maintain and support a dynamic provider network of care delivery partners through contracting and negotiation teams, provider relations, population health consulting, and access and capacity analysis for all applicable market segments in multiple geographies. Where appropriate, shepherds the connection of CareFirst network and all value-oriented contracts to the BCBSA to ensure CareFirst is supporting the broader goals and objectives approved by the BCBSA.
• Influence transformation of provider organizations leveraging CareFirst's data, analytic and reporting capabilities, leveraging practice transformation consultants to support health care delivery organizations in value-based contracts to make progress to value creation including better affordability, better access, and better outcomes on quality and member experience measures.
• Identify opportunities, and serve as the sponsor of specific initiatives, to establish new analytic capabilities that improve the quality and timeliness of actionable data in support of health care delivery system transformation and improves the access across geographies and intensify the effectiveness of population health activities. This includes claims data, clinical data and multi-dimensional utilization and geographic access data.
• Responsible for oversight of senior relationships with key health care delivery partners including practice transformation, data sharing and other activities used to drive the best value and outcomes in innovative payment arrangements. Serves as lead negotiator with large healthcare delivery systems and most complex business initiatives and finding compromises that enable progress. Role models and drives agreements that produce win-win for consumers, accounts, and the healthcare delivery partner that is a party to the agreement. Facilitates the shift from historically engrained behaviors and contracting approaches to new ways of nuancing health care delivery using imagination, curiosity and creativity as a leader.
• Oversees the strategic and the day-to-day activities of the Department, including directing, coaching, and guiding associates to implement departmental, divisional, and organizational mission/goals. Ensures alignment between and amongst inter-related departments specific to both broad goals as well as tactical implementation within CareFirst. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources.

SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business or a related field or equivalent business experience.

Experience: 12 years of related experience in healthcare environment or related industry and 7 years direct management experience. Must have experience with provider contracting, negotiation and reimbursement development; provider relations and recruitment; and/or network development.

Preferred Qualifications:

• MBA or CPA

Knowledge, Skills and Abilities (KSAs)

• Must possess superior management, negotiation and analytical skills and ability to motivate and persuade others. Management experience in managed care operations. Requires the ability to develop and maintain strong internal and external relationships.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $274,480 - $411,720

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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