Director, Program and Project Management (Payment Innovation)

About the 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.

Responsibilities

• 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
• Manage 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

Qualifications

• 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
• Previous experience in designing a program/initiative end-to-end, including conceptual design, implementation planning and execution, and on-going operational support
• Contract writing experience or experience in drafting documents
• Required knowledge and experience of health insurance business and structure, preferably within a payor
• Experience with aligning disparate stakeholders and driving towards outcomes
• Experience with payor data infrastructure, regulations for various lines of business and contracting preferred