Network Innovation Consultant Job:
Blue Cross and Blue Shield of Minnesota

19941-en_US
Blue Cross and Blue Shield of Minnesota
Eagan Minnesota
Healthcare
Description

For more than 80 years, Blue Cross and Blue Shield of Minnesota has been passionate about improving health. We provide quality, cost-effective health plans and innovative programs that make a healthy difference in people’s lives. Blue Cross is the largest health plan based in Minnesota, covering nearly 3 million members in the state and across the country. We strive to help all Minnesotans overcome the barriers to good health.



 



We offer our employees a comprehensive benefits, compensation and total rewards package to keep you and your family healthy and to secure your financial future. Our Employee Resource Groups help us advance health equity while promoting a diverse and inclusive work environment. Join us and make a healthy difference in people’s lives through the work you do every day. Together, we'll make Minnesota a better place to live — and a healthier one.


Description Summary

This position is responsible for creating a competitive advantage through network configurations and innovative payment arrangements.  The Manager is responsible for innovation and the strategic development of Blue Cross’ provider network including new reimbursement payment methodologies, development of new networks to meet market demands, aid in the development of Government Programs specific network needs and develop network strategies that improve overall health care affordability. These activities encompass all market segments including ASO, Large Group, Small Group, Individual, CCS and Government Programs.  This position will provide recommendations for the planning and implementation of network development activities and resources to meet regional and corporate business goals.


Accountabilities


  1. Directs the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

  2. Aid in the development of a comprehensive network strategy for each market segment and business line, Commercial Markets and Government Market Solutions, that ensures we have a plan to develop and implement network designs that ensure our networks are competitive in regards to quality, cost, access, and discount position.

  3. Develop strategies and tactics to improve Blue Cross’ market position with self-insured clients in regards to discount and Total Cost of Care position.  Execute the strategic plan by working collaboratively with others within Health Services and Commercial Markets to implement such strategies.

  4. Work with the Director Network Innovation to help evolve provider reimbursement from volume to value-based models, such as severity/complexity-based reimbursement or bundle payments.

  5. Manage the collection, integrity, and reporting of information/data related to payment methodologies and network strategy.

  6. Work with Directors of Provider Relations to develop negotiation strategies and tie payment methods to the tactics that are developed by this role.

  7. Develop innovative provider stratification processes based upon performance on cost, quality, access and other metrics and configure networks which meet product requirements.

  8. Leverage Blue Cross’ knowledge of provider performance to create transparency to customers and members that attracts them to affordable, high value providers.

  9. Works closely with the Sr. Director of Analytics to understand key drivers of Blue Cross competitive position and to develop strategies and tactics that will improve and influence Blue Cross’ competitive position for fully-insured, self-insured (discount position), and government market solutions.

  10. Oversees and manages the network analysis and network adequacy filing process for individual and small group market segments.

  11. Direct project management to ensure support, project management disciplines and leadership are executed on behalf of various assigned initiatives.

  12. Oversees the termination work group activities to help ensure network adequacy and member disruption in managed effectively.

  13. Drives the operationalization of new networks on old and new claims platforms.

  14. Responsible for conducting the roles and responsibilities described as part of this job description in compliance with and in support of the organization's code fo conduct and corporate policies.


Requirements

 




  • Bachelor’s degree in business, finance, healthcare administration or a related field.

  • 5 years of healthcare industry experience that includes 3 years of extensive experience in provider payment and data analysis, strategic planning and financial management.

  • 3 years staff, team lead or project lead experience.

  • Familiarity with health plan and provider contracting or revenue management is preferred.

  • Demonstrated expertise regarding the development of alternative healthcare reimbursement methodologies and innovative networks configurations.

  • Strong financial background and analytical skills with a deep understanding of the economic drivers of healthcare.

  • Familiarity with the delivery of health care services across the continuum and quality metrics.

  • Understanding of relational data tables and analytics.

  • Demonstrated leadership skills and experience in achieving goals through collaboration and teamwork.

  • Business expertise and interpersonal skills to effectively work within a complex organization to influence change.

  • Excellent written and oral communication skills with the ability to present complex information clearly and persuasively.

  • Advanced interpersonal skills and the ability to build relationships with and to influence a wide variety of influential internal and external stakeholders including senior leaders of the organization, customers and providers.

  • Highly creative and resourceful with an ability to effectively identify, collect, analyze, and present strategy; innovative thinker.

  • Strong organizational and time management abilities.

  • Proven experience leading teams on varied, complex and asymmetrical projects.

  • Ability to work independently and to make sound business decisions.


Preferred Requirements


  • Master’s Degree in Business, or a related field.



02Fin


FLSA Status

Exempt


Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Basic Qualifications
Requirement