The Senior Manager Cost of Healthcare (CoHC) ongoing program management and Implementation , is a member of the Blue Shield CoHC business unit and reports directly to the Director, CoHC ongoing Program Management. This position interfaces, supports and collaborates with the Directors of Sub-Budget management, as well as the Director of Ongoing Program Management, Senior Manager of Strategic Planning and Performance as well as other organization leaders and executive staff, including data and analytics, and cost of healthcare finance, and other departments as needed.
Senior Manager Cost of Healthcare (CoHC) ongoing program management and Implementation
is responsible for collaborating with stakeholders, departments for identifying, evaluating, designing and implementing healthcare reform and population health initiatives to support the reduction in cost of healthcare expenditures. Specifically, position supports the reduction of approximately $18B in annual cost of... healthcare expense. The Senior Manager will manage the evaluation, development and execution of initiatives that directly impact the cost of inpatient, outpatient, professional, pharmacy and ancillary services within the department portfolio. The role involves reviewing and analyzing clinical data with data analysis and the business owners, claims data, industry best practices, professional guidelines and industry program trends in order to assist with financial models and business cases for new and existing programs/initiatives that enhance member care, quality, and affordability of healthcare. The position is also accountable for the successful implementation of all CoHC programs and supporting the ongoing tracking of all program effectiveness and efficiency, provider abrasion and member access.
- Supporting the management of approximately $18B in annual cost of healthcare expense.
- Accountability for identification in collaboration with financial CoHC department, vetting, design and implementation of new programs/initiatives to support ongoing CoHC savings within the inpatient, outpatient, professional, pharmacy and ancillary services/budget.
- Leading a team of project managers who have accountability across sub-budget services to implement programs/initiatives that drive the highest cost in our membership.
- Partnering with sub-budget owners, on-going program management, strategic planning and performance and all those who collaborate with operational leaders and General Managers across all lines of business to establish and execute on data driven targeted cost of healthcare goals for the enterprise.
- Researching industry sources such as, but not limited to, CMS, AHRQ, NICE, ICER, Hayes, JAMA, IBIM, Blue Cross Blue Shield Association and Association plan members for emerging clinical and industry program trends; synthesizing that information into program opportunities, reviewing with clinical and operational leaders to formalize a clear program design.
- Partnering with data analytics teams to identify outlier data trends of healthcare services, unit cost and provider utilization trends, synthesizing that information into program opportunities, reviewing with clinical and operational leaders to formalize confident economic and financial models.
- Building and leveraging industry professional network relationships, including academic and community clinical thought leaders for emerging clinical and industry program trends, synthesizing that information into program opportunities, reviewing with clinical and operational leaders to formalize a clear program design.
- Partnering with finance and actuarial teams, operational leaders and/or vendors to create a sound business case with business needs, objectives, scope, program costs and program benefits and presenting to senior leaders for approval and/or funding.
- Development of strategic budgetary roadmap and tracking and monitoring of program and budget performance against the business case to demonstrate value in enhanced member care quality and improved stewardship of member premiums.
- Providing strong, innovative and collaborative leadership to your team and the overall department.
- Participation in Professional Society and BCBSA forums and committees.
- Developing strong relationships across key internal and external stakeholders to develop, align and execute on cost of healthcare goals.
Knowledge, Experience and Education
- Bachelor's degree, Masters preferred.
- Managed care knowledge (3 - 5+ years) with a strong understanding of utilization management, medical policy, healthcare and behavioral economics, contracting and health plan benefits.
- Minimum 10-year prior relevant experience, including 4 years of management experience.
- Expertise in the areas of corporate strategy, operations oversight, financial management, business development, and project management.
- Talent for generating high quality work products, build business strategies and financial plans, and utilizing data to develop actionable strategies to reduce healthcare costs.
- Strong independent judgment, critical and analytical thinking, problem-solving and data-driven decision-making skills.
- Ability to partner, collaborate with and influence relevant stakeholders, both internal and external. Strong oral and written communication, relationship and consensus-building skills.
- Strong knowledge and experience in healthcare payment, coverage and coding.
- Strong professional networking skills and presentation skills.
- Demonstrated ability to drive to quality decisions with teams, peers and leaders.
- Excellent Leadership/management skills, organization skills and facilitation skills.
- Experience with business case development and working with vendors.
- Strong understanding of the business of health care.
- Intermediate project management skills.
- Minimum of 3 - 5 years of progressive experience in a managed care or provider organization setting resulting in a similar leadership role.
- Ability to build trusting relationships with key internal and external stakeholders.
- Successful management experience in a complex managed care environment like Blue Shield, and the responsibility for associated budgets and expenses.
- Experience with LEAN and/or Six Sigma is preferred.
- About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
- Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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- EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
- Requisition ID: 210011B
- Posting Date: Jan 22, 2021
- Schedule: Full-time