A Career of Your Calling

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position has accountability to drive strategic partnerships with key provider partners, internal stakeholders and external provider relationships to establish and maintain a leading Medicare Advantage Provider Network. This person would work with the Medicare and Provider Relations leadership to establish strategy for Medicare network needs, collaborative initiatives and development of a contract structure that supports the Medicare Advantage strategy.  This person will additionally drive internal stakeholder relationships as it relates to Medicare Networks to ensure accountability and alignment within the organization. This role will work closely with Medicare P&L to ensure the provider strategy and Medicare strategy are aligned.

A Day in the Life:

• Partner closely with the Medicare team to establish and implement the Medicare Advantage Network Strategy. Acting as a representative for Provider Relations with Medicare leadership and as a representative for Medicare within Provider Relations will be the core accountability for this role.
• Oversees the success of value-based care program strategy for Medicare business. Accountable for development and implementation of the Medicare Advantage value-based care deals across provider types. Provides, develops, and implements strategic direction for the future state of the value-based care strategy. Convenes a Medicare network steering committee comprising of senior leaders to ensure alignment across the business
• Recommend terms in value-based deals with consideration for financial viability assessed in partnership with the financial modeling lead. Develops and implements performance tracking mechanisms to monitor contract effectiveness, and provide regular updates to Medicare Advantage and Provider relations leadership
• Build a strong direct relationship with Providers to enhance performance that surpasses the goals in value-based agreements. Take charge of the provider engagement strategy to boost performance by defining clear initiatives aligned with our Star ratings, risk coding precision, and cost-effectiveness of care strategies.
• Establishes strong relationships with BCBSM’s provider partners, actively participates in provider specific strategy setting, and serve as a key point of contact to guide value-based terms negotiations
• Act as the Medicare Advantage Network expert across Provider Relations, Actuary, Finance, Risk Adjustment, Quality, Value Based Agreements, Analytics and Medicare.  Ensuring open lines of communication across teams to address concerns, answer questions and gain execution.
• Represent the Provider Relations division on matrixed work teams and committees to represent the provider perspective and influence development of Medicare networks, products and initiatives that drive value and meet customer expectations and meet CMS and DHS requirements.
• Establish regular performance reviews, governance committee and lead a team to ensure the partnership across Medicare Advantage and Provider Relations

Nice to Have:

• Bachelor’s degree or MBA/master’s degree in business or a related field is preferred.
• 5+ years of experience in Medicare Advantage network development, provider relations, contracting or a combination

Required Skills and Experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.
• Demonstrated success with the development of executive-level relationships and managing complex strategies.
• Track record shaping value-based contract programs – defining value-based deals and monitoring contract performance
• Excellent written and oral communication skills with the ability to present complex information clearly and persuasively. Must be adept at formal presentations to both internal and external executives.
• Exceptional organizational and time management ability, with flexibility to change priorities as needed.
• Ability to influence key internal and external stakeholders.
• Seasoned business experience, financial knowledge, and interpersonal skills to effectively work through a complex organizational structure and influence change. Advanced interpersonal skills are necessary to effectively deal with sensitive, complex or ambiguous situations with a wide variety of influential people, both internally and externally.
• Proven experience leading multi-disciplinary teams and working as a team member in varied and complex projects.
• Ability to work independently, to make sound business decisions and handles a variety of challenging responsibilities.
• Broad knowledge of the health care industry, related local and national regulatory requirements or restraints, and financial risk arrangements with providers.

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.