Senior Provider Performance ConsultantHybrid Remote | Eagan, Minnesota
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 works with management team to design and develop innovative value-based payment models that support a high performing network across all market segments (Commercial, Medicaid and Medicare). This position works collaboratively with leaders in the department and cross functional teams and may lead initiatives focused on identifying actionable opportunities to aid in the improvement of provider performance based on the Triple Aim of affordability, experience and outcomes. This position will work with cross functional departments to support Provider Relations. This position will support all value-based program performance related activities (financial, utilization, quality, and other metrics) to ensure that these programs are working to improve quality of care while reducing costs. This position may provide department/divisional representation on corporate projects, manages customer (internal and external) data needs, provides input to the team, may be project lead on routine projects and may run work groups. This position receives assistance/direction from management or principal(s) on the team. This position requires minimal management direction.
A Day in the Life:
- Lead/support the design and development of innovative value-based payment models. Identify what data is needed, advise on provider reporting needs, identify initiatives to be focused on to improve total cost of care and quality.
- Serve as the provider performance expert and advise on actionable opportunities to drive performance improvement.
- Ability to develop financial negotiation strategies and support target setting and performance aspects of value-based negotiations with internal and external parties. Ability to perform moderately complex forecasting and modeling to support negotiations. Ability to support financial negotiations with internal and external parties. Ability to develop, analyze and report on shared savings reports for providers based on their unique contractual arrangement. Document methods, procedures and results.
- Collaborate with analytics team to develop tracking mechanisms to identify members attributed to a value-based program, assess performance relative to goals, and report to internal and external stakeholders. Collaborate with analytics team to develop bench-marking and scorecards to track provider performance.
- Work in partnership with value-based analytics team, STARS and Risk Adjustment team, quality improvement consultant and Medical Director on identification of actionable opportunities. Work in partnership with Quality Manager to develop new quality value-based programs and incorporate quality into existing or new programs.
- Ability to research, analyze, interpret and derive pertinent information from data and organize it in a methodical, logical and concise manner. Translate data into actionable information. Ensure that value-based programs performance data is shared with provider partners on a regular basis with emphasis on highlighting those areas in need of performance improvement.
- Present on pay-for-value topics to internal stakeholders and the provider network.
- Identify educational needs and opportunities for providers participating in value-based programs.
- Act as the primary contact to help providers understand clinical and economic opportunities to achieve the quality and financial goals of the value-based arrangements. Recommend reporting enhancements based on provider feedback and needs identified through regular use of the existing reporting tools.
- Serve as a knowledge expert around the setup of provider value-based programs. Understand how performance impacts placement in network, inform provider and contracting team, develop solutions in partnership with analytics team, product, care management and others to improve performance.
- May be project lead on routine projects and may run work groups.
- This position receives assistance/direction from management or principal(s) on the team. This position requires minimal management direction.
- Responsible to be attuned to industry related changes and advancements.
Nice to Have:
- Bachelor's and/or Master's degree.
Required Skills and Experiences:
- 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- Comprehensive working knowledge of healthcare claims and healthcare industry trends.
- Analytic skills in scenario modeling with thorough understanding of population health organizations and concepts, quality measures, performance measurements in relation to value-based care and risk contracts.
- Must be a self-motivated professional with sound judgment, excellent interpersonal skills, and the flexibility to adjust to changing priorities in a demanding, fast-paced environment.
- Excellent oral and written communication skills, including the ability to convey complex ideas through written reports, presentation materials and notes for senior executives.
- Ability to implement industry best practices and create an effective story line to present to internal stakeholders, as well as providers.
- Strong leadership, research, analytical, planning and problem-solving skills.
- Ability to lead, direct and facilitate work groups.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to identify workflows and recommend areas for improvement.
- Excellent organization skills.
- Solid proficiency in Word, Excel, PowerPoint, Access.
- Strong collaboration and relationship building skills.
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 email@example.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.
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