Commercial Segment Affordability - Program Manager

PRODUCT AFFORDABILITY (COST OF CARE MANAGEMENT)

• Lead Commercial Segment cost of care in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care.
• Partner with Clinical Excellence leadership to identify and implement effective utilization and care management activities, including strategic vendor partnerships as appropriate.
• Partner with Analytics to identify, analyze, interpret, and validate trends and patterns Commercial Plan utilization across provider panels, care settings and other categories, advising segment leadership team of affordability challenges and potential mitigating actions.
• Provide leadership and segment representation on corporate committees, advocating for Commercial customer needs and effectively communicating decisions and actions to segment leadership.
• Partner with Analytics to drive design and development of tools and reports that provide valuable insights leveraging a combination of internal and external data.
• 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.
• 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 Commercial Segment in Value-Based Partnerships, ensuring appropriate information sharing and monitoring outcome metrics in order to drive improved segment affordability and pricing predictability.

OVERALL

• Oversee day-to-day departmental administration by coaching and motivating staff and departmental personnel to make maximum use of experience and skills.
• Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
• 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.
• Coordinate activities between multiple divisions to achieve desired results.
• Support BCBSAZs Core Value of maintaining a heritage of service through community involvement.
• The position requires 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.
• Perform all other duties as assigned.

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 sklls
• Strong research and organization skills

• 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.

• 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

PREFERRED COMPETENCIES

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