Payment Transformation Manager
Location
Columbia, MD | United States
Job description
Resp & Qualifications
PURPOSE:
Manages a team of senior-level expert contributors who study, develop, execute and monitor and continuously improve new models to finance health care for CareFirst Members. The team drives CareFirst's effort to transition from a fee-for-service payment system which incents health care providers to generate volume to a payment approach that rewards providers for the value they create. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS: - Lead efforts to design and implement new payment models to drive improvements in the health care delivery system by introducing a thoughtful combination of incentives and risks to provider revenue; analyze current cost, quality and utilization data to identify areas of opportunity that can be impacted by new payment models; & ensure that new models are informed by data on current and historical performance and include quantifiable targets.
- Ensure team is maintaining a high level of awareness of provider performance and payment transformation efforts across the United States including BlueCross and BlueShield plans, other commercial insurers, Medicare Advantage plans, Medicaid Managed Care Organizations and provider-initiated programs; coordinate participation in workgroups sponsored by the BlueCross and BlueShield Association related to payment transformation; & lead benchmarking with the Organization for Economic Cooperation and Development (OECD) member countries health care system.
- Lead the interface with CareFirsts various data and Health Informatics teams to define and implement the mechanisms for measurement of the progress (or lack thereof) with the precision necessary to make payments to the providers; & oversee the team in producing a comprehensive quarterly report including qualitative and quantitative measures of progress, impact and outcomes.
- Day to Day Management and Development of team/Department oversight includes hiring; ensuring effective training & onboarding; observing performance in real time (within field) and providing regular performance feedback/coaching and annual performance reviews; covering when a key team member is on leave or there is a vacancy. Oversight of departmental budget.
SUPERVISORY RESPONSIBILITY: This position manages people.
QUALIFICATIONS: Education Level: Master's Degree in Public Health, Health Administration, Applied Economics, Business Administration, or related field OR in lieu of a Master's degree, an additional 6 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years Increasing responsibility in a healthcare, insurance payer and management or experience and 2 years developing and implementing value-based payment arrangements.
1 year supervisory experience or demonstrated progressive leadership experience
Knowledge, Skills and Abilities (KSAs)- Strong interpersonal skills. Ability to work independently, as well as a member of a team.
- Strong critical reasoning skills in clinical decision-making, planning and organizing.
- Current knowledge of clinical practices and related information systems and computer applications, required.
- Knowledge of professional knowledge and skills related to pharmacy practice.
- Knowledge of accounting and finances with understanding of CareFirst structure and systems.
Salary Range: $109,520 - $203,297
Travel Requirements: Estimate Amount: 20% Local travel for meetings with provider partners.
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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