Value Based Care Program Manager I
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Manage relationships with provider organizations for new value based programs that support the corporate vision for value-based programs (VBP). Coordinate implementation of programs with operational, financial and clinical leadership. Build a collaborative framework to facilitate exchange of ideas and be an advocate for the operations component of all VBPs developed. Responsible for all implementation plans developed for rolling out new programs and changes to existing programs.
REQUIRED QUALIFICATIONSRequired Work Experience
- 5 years of experience in a healthcare field
- 2 years of experience working on Value Based Programs
- Bachelor’s Degree in healthcare or business-related field of study (Applies to All Levels)
PREFERRED QUALIFICATIONSPreferred Work Experience
- Experience working with Medicare STARS, Risk Adjustment, HEDIS or other quality initiative
- Registered Nurse with active unrestricted Arizona license
- Certification in one or more healthcare quality and/or accreditation functions (e.g. NCQA Content Expert
ESSENTIAL job functions AND RESPONSIBILITIES
LEVEL 1 Functions with general support from Management
- Collaborate with contracted value based care program participants to achieve program goals.
- Be single point of contact for the plan for VBC program participants to ensure they receive concierge level of service.
- Facilitate meetings between the plan and VBC program participants, including sessions with program leads, monthly joint operating committee meetings, and clinical reviews.
- Review and communicate results of reports developing a complete understanding of the tools and criteria used to generate the reporting.
- Ensure VBC program participant provides required documentation to support plan quality initiatives including STARS, Risk Adjustment, HEDIS and well as others.
- Provide education and training to program participants regarding criteria for compliance with measures
- Collaborate with segment leads to ensure clear understanding of their goals and objectives with the VBC relationship.
- Maintain effective working relationships with multiple areas within the organization.
LEVEL 2 Functions with limited support from Management
- Implement new VBC relationships, using framework to ensure deliverables on both sides are met.
- Use process improvement tools to identify areas of improvement with the VBC relationship.
- Interact with internal departments within the company including Data Analytics, Integrated Care Management, Provider Partnerships, Medical Directors, Internal Audit and Actuarial.
- Collaborate with Population Health Management team and provide feedback on VBC performance specific to individual program participants and program as a whole
- Support internal departments with coordinating requests for integration into VBC including Risk Adjustment, HEDIS data collection and other initiatives as identified.
- Develop a playbook for implementing new programs with key factors and timelines that highlight key milestones and risks.
- Develop wide knowledge base of VBC capabilities and ways the plan can support positive outcomes from the program.
- Work with vendors to implement pilots or programs that support the corporate vision for Value Based Programs including providing guidance on current program requirements and future expected state.
Level 3 Functions independently with limited oversight from Management
- Mentor and support new VBC Program Manager staff.
- Participate in evaluation of program’s effectiveness both from an internal Plan and external provider practice perspective.
- Identify and implement opportunities for collaboration with vendors to improve the program outcomes.
- Each progressive level includes the ability to perform the essential functions of any lower levels.
- 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.
- In state travel is required for onsite visits to practices and provider organizations; After hours sessions with practices are also required.
- Perform all other duties as assigned .
Required Job Skills
- Intermediate PC proficiency, including spreadsheet software
- Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (All Levels)
Required Professional Competencies (All Levels )
- Strong interpersonal skills
- Strong verbal and written communication skills
- Excellent customer service skills
- Strong presentation and facilitation skills
- Strong critical thinking skills
- Analytic skills to review and analyze data to make decisions
- Excellent organizational skills to coordinate projects and activities
- Demonstrated ability to handle multiple priorities
- Demonstrated understanding of health care issues
- Innovative and creative problem solving skills)
Required Leadership Experience and Competencies
Preferred Job Skills
Preferred Professional Competencies
- Knowledge of electronic health records (All Levels)
- Project Management
- Use of process improvement tools including Six Sigma
Preferred Leadership Experience and Competencies
- Leadership skills (including knowledge of teamwork concepts) to accomplish fast paced results in a collaborative team setting
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona