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Florida Blue (Blue Cross and Blue Shield of Florida) is Hiring a Senior Director Value-Based Contracts Near Florida, NY
Job DescriptionThe successful candidate must be able to translate strategy to action. The individual is someone who sees a new Value-based Care ("VBC") business model and knows how to solve/implement it. Frequently, this leader must partner with the client/provider organization utilizing his/her VBC subject matter expertise to build new business models, operating models, and care models to succeed in our continued transformation towards value. The Sr. Director, in conjunction with Vice President and leadership team, must deliberately build an internal culture where the intersection of quality of care, affordability, and patient experience is the highest priority. This includes consultations with physician practices, account management with business stakeholders, and the project management of internal and external resources to meet deliverable expectations. Job Duties Include But Are Not Limited To
Advances the company strategy to adopt value-based payment models
Develops competencies to understand rules and regulations of value-based programs
Develops and implements network configurations and incentive-based models as appropriate to deliver on quality and high-performing networks to support business objectives for Medical Loss Ratios (MLR) targets, growth and income results
Facilitates and leads the strategic planning process for the development, implementation and management of value-based networks focused on favorable unit cost performance as well as overall medical costs
Formulates and implements alternative reimbursement methodologies for various provider types that ensures departmental and enterprise goals are achieved
Ensures compliance with value based contracting pricing guidelines as well as familiarity with alternative payment models (APM) framework, bundled payments, condition-specific capitation, hospital physician gain sharing, and pay for performance options
Leads teams to develop, negotiate and manage complex Value Based and Alternative Payment Model (APM) relationships
Collaborates with leadership on selection and ongoing analysis of potential VBC programs and partners
Defines targets both financially and qualitatively with leadership
Facilitates implementation and executes on value-based initiatives
Serves as the business lead for all IT projects associated with Value Base Network arrangements, including the development of the strategy and business requirements to support value-based program expansion
Serves as business initiative owner for Association and Industry VBC committees
Oversees the negotiation, implementation and management of VBC agreements
Monitors performance throughout program’s term and collaborates with the Value Base Coaching team to implement effective strategies and tactics to improve VBC relationship
Develops and manages Value Base Contract scorecard to support departmental and enterprise goals
Coordinates with internal and external partners to reconcile data for both financial and qualitative purposes
Serves as business sponsor for all outside vendors engagements; defines requirements and scopes of work
Develops and maintains relationships with clients and project stakeholders
Conducts assessments to identify physician practice value-based readiness, including strengths, weaknesses, opportunities, and threats
Measures business performance; identifies and quantifies KPI drivers, risks and opportunities for business performance and define solutions to mitigate risks and leverage opportunities for the benefit of VBC clients
Recruits, motivates, retains, develops and leads a team of professionals to achieve target results
Works within a team environment
Establishes contacts and enhances relationships with healthcare professionals, associations, advisory groups and community task forces by exhibiting knowledge, technical competency, reliability and professionalism
Identifies opportunities to mentor and coach others to achieve results, and is open to cultural and geographic diversity
Manages time, territory, costs and administrative requirements by effectively planning and carrying out plans to ensure that support activities are achieved at reasonable costs
Job Requirements
Related Bachelor’s degree or additional related equivalent work experience Management, Business Administration, Health Care Administration or closely related field
8 years related work experience. Experience Details: Provider Management or Health Plan management leadership experience
5 years management/supervisory experience
Both tactical, and strategic experience working within healthcare provider networks as well as large group physician practice operations. Health system experience is a plus
Expert level of proficiency with provider / facility / ancillary contract reimbursement methodologies
Expert knowledge of business processes that impact physician practice, facility, and/or ancillary provider operational results
Knowledge of healthcare practice management and electronic medical records systems
Demonstrated management skills that include making effective and efficient decisions and prudent judgment to achieve long-range and short-term goals
Ability to bring together a variety of functions in a spirit of strategic harmony and with a single-minded purpose
Solid project management skills and ability to produce high-quality and timely deliverables within a project-focused environment. Capable of managing multiple priorities simultaneously
Experience working with large data sets, creating ad hoc reports, and presentations
Demonstrates effective proactive problem-solving ability while maintaining compliance protocols
Solid understanding of value-based healthcare economics, including knowledge of impact to physician practice and managed care environments
Preferred
Strong consulting skills and ability to facilitate problem resolution process
Experience working within the healthcare industry, particularly in the delivery system (hospital clinic, physician practice)
Practice Management
What We OfferAs a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, Short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan includes employer contribution and employer match;
Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
Additional voluntary benefits available; and
A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Annualized Salary Range: $144,000 - $234,000 Typical Annualized Hiring Range: $144,000 - $180,000 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities. About UsAt GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from. From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone’s contribution has the power to help people and communities achieve better health. Find your new team today. About The TeamFlorida Blue, A GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communicating to achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the members first.