Director Provider Performance Programs at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Bring your drive for excellence, team orientation and customer commitment to IBC; help us renew and reimagine our business and shape the future of health care.  Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team.  If this describes you, we want to speak with you.

POSITION SUMMARY:

Leads continuous development and evolution of Independence’s current programs, provides contractual, implementation and ongoing management of Independence's provider performance programs and related short and long term strategies. Provides overall management of the processes surrounding provider incentive programs, including their implementation, ongoing maintenance and daily activities required to manage these programs. Manages a staff responsible for the ongoing management of program design and provider specific performance programs and contracts. Working closely with provider contracting, actuarial and informatics departments, analyzes the financial and operational performance of incentive programs.

MAJOR ACCOUNTABILITIES:

• Responsible for the development and maintenance of Independence provider value-based incentive programs, including physician, hospital, integrated delivery system and other provider entity incentive programs and contracts.


• Working in conjunction with the contracting leadership team, coordinates the ongoing development and management of IBC performance programs strategy.


• Responsible for monitoring external developments that impact Independence's provider value-based incentive reimbursement strategy, including developments related to state and/or Federal health care reform initiatives.


• Acts as the primary external representative for Independence provider performance programs, including the ongoing socialization of Independence programs with its provider network.

• Interfaces closely with provider contracting managers to ensure alignment and awareness of incentive programs and their impact on overall provider relationship.


• Responsible for the planning and implementation process for all incentive programs/ contracts; including the development and maintenance of business requirements, system modifications, operational controls and related metrics.


• Leadership role in a cross functional Joint Value committee responsible for evaluating financial and operational performance of incentive programs, strategic planning, opportunity analysis and issue resolution.


• Responsible for developing and tracking the medical costs budgets for all incentive programs.


• Works closely with provider communications to ensure timely and accurate communication of incentive program changes.


• Manages the financial analysis of provider incentives programs; coordinates reporting needs and evaluation with informatics and actuarial counterparts.


• Performs other job-related duties as assigned.

EDUCATION AND EXPERIENCE:

• Bachelor’s degree with at least 8-10 years' progressive experience in healthcare/managed care.


• Thorough understanding of managed care finance, operations and processes is required.


• Previous experience in provider contracting and reimbursement, finance, health care analytics/informatics and operations is preferred.


• Candidate will have demonstrated experience and industry knowledge and familiarity with value-based incentive programs including ‘upside and downside’ risk/reward models, full-risk models including percent of premium, population health management premises, Episode of Care programs, various capitation methodologies and other programs.


• Candidate must have excellent leadership, analytic, interpersonal, and communication skills, demonstrated ability to implement strategic initiatives in support of corporate objectives and the ability to organize and manage multiple priorities.


• Candidate must have strong personnel, project and process management skills and a strong internal and external customer focus.


• Candidate must also be able adapt quickly and easily to a rapidly changing business environment.