Affordability Program Manager - Hybrid

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.

Partner with Workstream leadership to identify and implement Affordability Initiatives impacting the Segment (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.).

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.

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.
• Cookordination activities between multiple divisions to achieve desired results.

Essential Job Functions And Responsibilities

• Have an onsite expectation of 1 day per week and require 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.

Required Qualifications

• 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.

Preferred Qualifications

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

• Essential Job Functions And Responsibilities

Required Competencies

• 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.

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.

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.

Pay

Commensurate with experience.

Schedule

Full-time.