This job listing has expired and the position may no longer be open for hire.

Director, Cost of Healthcare Ongoing Program Management at Blue Shield of CA in rancho cordova, California

Posted in Other 30+ days ago.

Type: Full Time





Job Description:

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. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us! The Director, Cost of Healthcare Ongoing Program Management, is a member of the Blue Shield Healthcare Quality and Affordability (HCQA) business unit and reports directly to the VP, Cost of Healthcare. This position interfaces, supports and collaborates with the Director, Finance Analytics and Cost of Healthcare, the Sr Manager, Program Assessment, Design and Implementation as well as other organization leaders and executive staff, and data and analytics. The Director will lead a team which will include senior managers, program managers and business analysts. The Director of Cost of Healthcare Program Management is responsible for managing existing (inpatient, outpatient, professional, pharmacy and ancillary services) program performance ensuring each initiative is meeting quality of care, operational efficiency and financial cost of healthcare objectives.

Specifically, the Director of Cost of Healthcare Ongoing Program Management is responsible for supporting the reduction of approximately $18B in annual cost of healthcare expense by managing and enhancing initiatives in the areas of inpatient, outpatient, professional, pharmacy and ancillary services that impact the overall cost of healthcare expense. The Director will lead the senior managers responsible for the initiative portfolio and be responsible for strategic direction, risk assessment and portfolio performance. In addition, the Director will lead enhancements to the ongoing initiatives and/or programs to help support cost of healthcare savings in each sub-budget. The role involves reviewing and analyzing clinical data, claims data, industry best practices, professional guidelines, new technology and industry program trends in order to effectively manage and enhance new and existing programs/initiatives that enhance member care, quality, and affordability of healthcare

This Director, Cost of Healthcare Ongoing Program Management is specifically responsible for:

* Accountability for the strategic direction, risk mitigation, enhanced performance and efficacy measurements of new programs/initiatives to support ongoing CoHC savings within the inpatient, outpatient, professional, pharmacy and ancillary services/budget portfolio

* Leading a team of Sr Managers and Program Managers who have accountability across sub-budget services that drives the highest cost in our membership

* Partnering with sub-budget owners, program assessment, design and implementation team, strategic planning and performance team 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.

* Partnering with data and analytics and planning to support development of monthly KPI reports and tracking tools.

* Partnering with finance and actuarial teams, operational leaders and/or vendors to create a sound business case with business need, objectives, scope, program costs and program benefits

* Manage day to day operations of existing programs.

* Develop enhancements to the programs to achieve maximum clinical and business impact and performance.

* Proactively manage relationships with provider partnership team to maximize engagement and minimize abrasion

* Manage operational activities including claims adjudication, where necessary

* Work with cross-functional teams and Markets to inform and provide updates on performance and quality

* Provide thought leadership in areas of focus, including industry best practices and emerging trends and incorporate relevant information into program design and operations

* Providing strong, innovative and collaborative leadership to the team and 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.

The Director, Cost of Healthcare Ongoing Program Management, is a member of the Blue Shield Healthcare Quality and Affordability (HCQA) business unit and reports directly to the VP, Cost of Healthcare. This position interfaces, supports and collaborates with the Director, Finance Analytics and Cost of Healthcare, the Sr Manager, Program Assessment, Design and Implementation as well as other organization leaders and executive staff, and data and analytics. The Director will lead a team which will include senior managers, program managers and business analysts. The Director of Cost of Healthcare Program Management is responsible for managing existing (inpatient, outpatient, professional, pharmacy and ancillary services) program performance ensuring each initiative is meeting quality of care, operational efficiency and financial cost of healthcare objectives.

Specifically, the Director of Cost of Healthcare Ongoing Program Management is responsible for supporting the reduction of approximately $18B in annual cost of healthcare expense by managing and enhancing initiatives in the areas of inpatient, outpatient, professional, pharmacy and ancillary services that impact the overall cost of healthcare expense. The Director will lead the senior managers responsible for the initiative portfolio and be responsible for strategic direction, risk assessment and portfolio performance. In addition, the Director will lead enhancements to the ongoing initiatives and/or programs to help support cost of healthcare savings in each sub-budget.

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.