Director Medical Cost Transformation at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. 

The Director of Medical Cost Enablement (MCT) role provides the opportunity for someone to build upon their strong analytic skills and add in their healthcare knowledge to help drive strategies across creating self-funded client value, bending the medical cost curve, and reducing administrative cost burdens. You will lead the financial business case development for high impact initiatives, inform and develop HVO strategies to achieve annual financial goals, drive executive stakeholder agreement, and drive ROI monitoring for medical cost trend reduction programs.    You will establish the medical cost strategy for medium and high valued cost initiatives using in depth internal and external information to enable executive decision making.  Additionally

• Leads the high valued initiatives from business case development and stakeholder agreement through stabilization and ongoing ROI monitoring phases cross functionally.  


• Leads financial business case development for new high value initiatives along with ongoing performance assessment of current initiatives


• Drives opportunity analyses aimed at driving strategic revenue targets, innovating in the clinical care space, supporting initiatives to drive process efficiencies, and determining the best course of action for a medical cost reduction strategy


• Supports vendor assessments to determine the true value of a proposed solution


• Develops clear, articulate, actionable business case in a manner for an executive audience; post implementation stabilization monitoring strategy, ROI monitoring strategy.


• Prepares executive level materials for presentation to SVP / EVP leaders and decision makers. 


• Supports the Director & Vice President responsible for overall medical cost program administration and workstream matrix support.               


• Supports the HVO leadership team in defining the program-level strategy to achieve medical cost savings targets.               


• Ensures data is produced/accurately interpreted; complete investigation of IBC, market/peer precedent, network disruption; packages and facilitates decision making around approach.


• Provides concept and tactical knowledge and support to the assigned implementation program manager through implementation and organizational readiness.                                                  


• Lead in managing business issues during the stabilization phase post implementation Lead in monitoring ongoing ROI phase post implementation.          


• Leads the preparation of collateral designed to convey overall program status, risks and barriers to senior leaders and executives.                                    


• Leads the preparation of collateral designed to convey the provider abrasion plan for high impact initiatives.                         


• Understands principles of change management, performance metrics and dialogs, particularly in health systems and drives change at all levels.


• Able to provide leadership over and influence individuals and across multiple stakeholders from different levels / backgrounds by tailoring approach      

Qualifications:

• Bachelor's Degree required, advanced degree MBA / MHA etc. desired.


• Management Consulting, Actuary, and / or Finance background desired. 


• Healthcare Payor experience highly preferred.


• Appropriate designations ASA, FSA, and / or CPA preferred but not required.