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Principal Provider Clinical Consultant

Hybrid | Eagan, Minnesota
Job ID: R0005485 Career Area: Strategic Planning/Corporate Development Date Posted: 05/06/2025
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About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

In this role, you will be a key element in the design and implementation of the Medicare Provider Performance Consultation model supporting providers on Medicare path to risk agreements.  In this role, you will work in tandem with the Manager of Clinical Consultation and the Medical Director to review provider-specific data and to identify actionable clinical opportunities.  The role leads face-to-face meetings with leaders in provider care systems and is responsible for forming partnerships with providers to develop and execute provider-specific action plans to improve health care cost/utilization trends.

Your Responsibilities

  • Point on advising and leading consultative conversations with provider groups about opportunities to improve clinical and cost/utilization trend.
  • Responsible for developing and executing on provider-specific action plans for care systems with Medicare path-to-risk arrangements.
  • Contributes to the design of provider-facing clinical consultation tools, processes, supporting resources to supports Medicare provider in risk agreements
  • Facilitates discussion of opportunities identified based on review of value-based cost and utilization performance data in provider-facing meetings.  
  • Works closely with Medical Director and Medicare Network Director to review data and identify provider-specific opportunities related to Medicare PTR target measures
  • Advises on business needs to provider-performance data owners to ensure reporting meets the needs of clinical consultation and oversight conversations with providers

Required Skills and Experience

  • 7+ years of related professional experience.  All relevant experience including work, education, transferable skills, and military experience will be considered.
  • Possess relevant degree or extensive experience in healthcare, clinical care, or public health.
  • Excellent executive presence. Collaborative, interpersonal, verbal and written communication skill and demonstrated ability to develop accurate and appropriate communication to all levels of management.
  • Demonstrated track record of achievement with ability to influence change and identify customer expectations, barriers, and issues.
  • Creative problem-solving skills, adapting approach as needed.
  • Excellent facilitation and relationship building skills.
  • Demonstrated ability to work independently and make decisions as needed.
  • Expert level ability to make decisions based on analysis and business needs.
  • Exceptional ability to work in high paced environment, handling multiple responsibilities and projects.

Preferred Skills and Experience

  • Bachelor's degree.
  • Fundamental data analysis and transforming raw data into meaningful insights
  • Experience with value-based payment arrangements.

Compensation and Benefits:

Pay Range: $100,000.00 - $135,000.00 - $170,000.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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