When you think of where you want to go in life, being part of a great company figures into your vision. You have the talent and the drive to go far. What you want is a company with the culture and the opportunities to enable you to reach your goals.
Blue Cross Blue Shield of Massachusetts is well-known for supporting and encouraging employee achievement in an environment of abundant growth opportunities, career paths and financial rewards. You can expect no less from a health insurance leader whose innovative solutions bring coverage into the homes of millions across our state and serve as models for the entire nation.
You are invited to apply for the following opening:
Director, Contracting and Institutional Reimbursement Strategy
Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us.
Blue Cross Blue Shield of Massachusetts is an Equal Opportunity
Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.
This highly visible, leadership position, reporting directly to the Executive Director, Healthcare Contracting and Network Strategy is responsible for collaborating with Health Care Contract Management's (HCCM)Senior Leadership and other company
leaders to develop, adapt and evolve the short and long-range provider contracting strategy for the corporation. This position works directly with senior leadership within the company to define and evaluate selected initiatives that have the potential to positively impact the company's long-term success. In addition, the scope of this position includes developing and executing a long term institutional provider reimbursement methodology and strategy, including the review, analysis, and modification of
the current institutional reimbursement methodology.
Essential Functions
Qualifications
Blue Cross Blue Shield of Massachusetts is an Equal Opportunity
Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.
This highly visible, leadership position, reporting directly to the Executive Director, Healthcare Contracting and Network Strategy is responsible for collaborating with Health Care Contract Management's (HCCM)Senior Leadership and other company
leaders to develop, adapt and evolve the short and long-range provider contracting strategy for the corporation. This position works directly with senior leadership within the company to define and evaluate selected initiatives that have the potential to positively impact the company's long-term success. In addition, the scope of this position includes developing and executing a long term institutional provider reimbursement methodology and strategy, including the review, analysis, and modification of
the current institutional reimbursement methodology.
Essential Functions
- Directly accountable for managing an inclusive institutional provider reimbursement strategic planning process, which requires extensive collaboration with HCCM and other senior leaders to create and adjust strategic areas of focus in provider contracting and institutional provider reimbursement strategic planning process. Establish key impact measures and goals to support the strategic planning process and identify the key supporting initiatives that will achieve HCCM and the company's short and long-term strategic goals and objectives.
- Responsible for Institutional Reimbursement methodology Review including accountability for Preferred Reimbursement Methodologies, Ancillary Providers, and boilerplate modifications.
- Accountable for integration of both national and local payment reform efforts, including implementation of legislative mandated payment methodologies and contractual payment terms.
- Assume a primary role assisting the Executive Director of Healthcare Contracting and Network Strategy on the development and updating of the HCCM strategic plan annually and prepare all of the supporting documents that are presented to HCCM Senior Leadership for review and approval.
- Defining the scope and identifying strategic outcomes, goals, objectives, and timeframes.
- Development of project plans, collection of business information, and internal organizational analysis necessary to identify business drivers.
- Categorization and analysis of collected data, including the identification, validation, and reporting of key findings, conclusions, and recommendations.
- Analyze, develop, and implement reimbursement strategies for the successful modification and implementation of institutional provider reimbursement methodologies, to support organizational efforts around improved quality, trend management, and payment reform activities.
- Drives the management of core processes and major projects, through planning, organizing, leading, and managing assigned resources and budget
- Develops and coaches a quality conscious service-oriented dedicated team of professionals focused on process improvement, cost-effectiveness, and operational efficiency
- Influences associates' results-oriented behavior through communication, motivation, teambuilding, leadership, and discipline
- Inspires subordinate leaders to motivate associates
- Develops depth and bench strength in subordinate leaders
- Demonstrates excellent oral and written communications through organizing, running and participating in meetings and work teams, analysis and report generation, correspondence, and preparing and delivering presentations
- Understanding key industry trends and/or issues; defining implications for the organization and formulating potential strategic responses.
- Manage the annual strategic planning process. Identify and implement process improvements as needed.
- Manage a new balanced scorecard that captures measures and targets for each strategic objective.
- Define recommendations for internal operational improvements,
organizational effectiveness, strategic options and/or change management methods. - Direct supervision of 1-2 professional-level associates within the strategic planning team
Qualifications
- Demonstrated knowledge and understanding of the health care industry, specifically as it relates to contemporary and future trends in the delivery, and financing of health services
- Strong understanding of strategic and operational planning concepts and methodologies
- Strong interpersonal skills and ability to effectively collaborate with and influence others at all organizational levels
- High level of organizational astuteness; professionalism and poise
- Solid knowledge of the core operational processes that exist within an insurance company
- Ability to develop and articulate general strategies and detailed operational plans
- Ability to effectively plan and facilitate organized and productive meetings/workgroups
- Demonstrated leadership skills in team and/or group settings
- Very strong communication and presentation delivery skills
- High degree of initiative along with ability to act as a team player
- Ability to deal effectively with ambiguous situations
- Executive presence
- Bachelor's Degree or equivalent required
- Masters Degree in Business Administration or other advanced degree preferred
- Demonstrated experience in strategic and operational planning
- 2-3 years experience managing and coaching others (especially professional level staff)
- 5-7 years experience in the health care industry preferred; not required
- 8-10 years of overall business experience; with progressive leadership positions in health care, financial services and/or management consulting.
- Position Information
- Location: 02215
- Job Category: Business/Strategic Management
- Reference Code: bcbs-00002399
