Senior Manager, Payment Innovation

Description  Position Summary: At Blue Shield of California, we are committed to creating a healthcare system that is worthy of our family and friends and sustainably affordable. We realize that achieving this mission will require a complete transformation of the care delivery system. In order to jump start this transformation, we have created an innovation program within our Health Care Quality & Affordability function called Health Care Model of the Future where we will be piloting bold transformations in select ecosystems in California in service of our mission.  We know our current fee for service payment system often incents inappropriate care and creates barriers to optimal care and value. As a payer we are committed to paying for the right care and partnering with providers to redesign payment models. Reporting to the Senior Director, Payment Innovation, the Senior Manager, Payment Innovation leads the design, development and implementation of clinical and payment models across multiple specialty areas at pilot sites, keeping potential scale in mind.  This role will be responsible for driving strategic alignment and integration across projects/programs in support of business unit process and administrative efficiency.  The Senior Manager will define projects required to support programs and partners to ensure their implementation is on time, within budget and with benefits realized including assisting in the planning and direction of budgets.  The Senior Manager manages a small team of Program Managers, Program Coordinators and Translational Analysts, and works directly with pilot leaders and targeted provider practices, and partners with other parts of Blue Shield of California to accomplish these goals.  Travel to pilot sites at least monthly required. Responsibilities:  Design, develop and implement new and innovative payment and clinical transformation models across multiple specialty areas to promote better health and outcomes. Partner with the Pilot leader(s) on implementation planning and execution. Support the Senior Director in identifying and designing scaling strategies to offer new models of care and payment statewide. Leads planning, budgeting, and project management for designated projects related to specialty care transformation as needed. Lead work to select new specialty care areas using an evidence process, and in collaboration with other HCQA business teams.  Plan for implementation of new specialty care areas in 2019 and beyond as identified within the strategic portfolio for HCQA. Partner with the Senior Director and internal and external communications departments to tell the story of how these programs benefit BSC members. Work across BSC to make needed operational, contractual and policy changes needed to deploy and scale new payment models. Qualifications  Minimum Education & Experience Requirements: Bachelor's degree is required; advanced degree (MBA, MHA, MPA, or equivalent) preferred. Minimum 10-year prior relevant experience, including 4 years of management experience. Technical knowledge of payment model design and experience implementing new payment models with physicians.  Working operational knowledge of the key synergies necessary among practices, payers, community and policy leaders to better align health care transformation efforts. Requires practical knowledge in leading and managing the execution of processes, projects and tactics within an area. Has advanced knowledge and skills including technical or functional expertise, business acumen, financial analysis skills, risk management, delegation skills, critical thinking and decision-making skills.  Clinical training and experience preferred.   Knowledge & Skills: Highly talented leader, with the ability and desire to think creatively and innovatively.  Strong influence skills, including with physicians and others in clinical practices. Ability to lead and manage significant change in complex environments.  Demonstrated experience with change and organization management. Possess a performance and results driven management style. 18002HO
Salary Range: NA
Minimum Qualification
11 - 15 years

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