VP Network Solutions
Leads the BCBSA efforts to enable Blue Cross and/or Blue Shield Licensee’s success through the delivery of creative and innovative solutions that promote the strength of Blue networks, enhance the value of national networks, meet/exceed market needs, and demonstrate value; including leading all aspects of the Blue Distinction portfolio, Blue High Performance network (BlueHPN), and value-based network solutions. Anticipates opportunities, proactively implements solutions and ensures day-to-day operations of national network solutions meet Plans’ and market expectations. Leverages existing and builds new relationships with industry thought leaders, analytic vendors, Plan clients, Consortium Health Plans, Plan senior leadership as well as developing relationships to achieve Plan goals and objectives.
Responsibilities include but are not limited to:
- Accountable for the development of strategic plans and solutions to address emerging network requirements.
- Ensures that network solutions and provider measurement activities meet market requirements for access to care, higher quality, lower costs, and improved efficiency.
- Directs market research and the development of creative and innovative approaches to address market requirements.
- Leads development and execution of multi-year business plan that addresses current and emerging market demands, BCBS Plan priorities, and enable solutions designed to improve quality of care and generate.
- Oversees the development of marketing activities, including program messaging of program value and value, analytics such as program efficiency and effectiveness research.
- Owner of National Network Solutions, including but not limited to Specialty Care (centers of excellences for certain specialty areas), Total Care (Value-Based Programs), the Blue High Performance Network (BlueHPN) and tiered benefit solutions based on quality and cost criteria.
- Leads and develops staff in support of BCBSA and division initiatives.
- Ensures successful operation of the department by selecting, supervising, developing and evaluating the activities of subordinate staff and measure the effectiveness of their efforts in meeting departmental objectives.
- Conducts required/effective management responsibilities including taking corrective action when necessary and ensure that all activities are performed in compliance BCBSA policies, standards, and procedures.
- Builds a culture to support BCBSA values and leadership competencies and deliver operational excellence and efficiency.
- Provide appropriate and effective mentoring, coaching and feedback to staff members as appropriate.
- Oversees financial oversight of the revenues and expenses associated with National Network Solutions. Ensures programs are delivered within budget and revenue targets are met. Identifies new revenue sources based on offering value added services to BCBS Plans and their customers.
- Lead the engagement and collaboration with key external public and private stakeholder groups to improve healthcare value for BCBS Plans and their accounts and consumers.
- Leverage successful relationships with external partners including prover specialty organizations, industry stakeholders, Plans, Plan customers, and Plans’ strategic partners to.
- Leads cross-functional teams and stakeholders groups across BCBSA, Plans and other organizations to ensure that the National Network Solutions lead to increased opportunities for growth and improvement of quality and value.
- Build internal BCBSA and Licensee consensus on solutions that enhance the experience with the Blue System, through thoughtful engagement, demonstrated business acumen and influence.
- Accountable for Network Executive Council.
- Present to BCBSA Board Governance Committees, Advisory Committees and Workgroups, and gain approval of network strategies, development efforts and implementation approaches.
- Represents BCBSA and Blue Cross and/or Blue Shield Plans in external efforts.
Provider Measurement, Analytics and Reporting
- Provides strategic leadership and direction to cross-divisional BCBSA initiatives to maximize measurable improvements in healthcare value for covered members.
- Directs provider measurement strategy development related to network solutions, identifying opportunities to improve the quality of care, reduce spending on health care costs, and recognize operational effectiveness.
- Ensures measurement methodologies align with industry approved measures and partners with clinical colleagues.
- Influences industry efforts to develop and enhance provider quality, cost and effectiveness. Builds and maintains strong relationships.
- Ensures national network solutions/programs meet and/or exceed identified cost, quality and efficiency success metrics.
- Provides thought leadership to industry stakeholder groups, Plan executives, cross-functional internal BCBSA initiatives that involve networks and provider measurement.
- Lead, direct and set strategic priorities for all National Network Solutions operations. This may include vendor selection, contract negotiation and vendor management; daily operations, performance auditing, problem resolution, Plan education and billing.
- Responsible for the definition and implementation of system changes and enhancements to the vendor systems that support all National Network Solution operations.
- Ensures programs meet success measures including operational SLAs, provider quality and costs targets, and market adoption goals.
Other Job Functions:
- Provide strategic direction to cross-divisional BCBSA initiatives to maximize potential for measurable improvements in healthcare value for covered members.
Required Basic Qualifications:
- Bachelor’s degree in business, healthcare or equivalent experience
- Minimum 10 years of progressive health insurance experience in combination of product/business development, networks and operations
- Minimum 10 years of management experience including managing staff and budget
- Minimum 10 years’ experience with the development and implementation of major initiatives
- Minimum of 10 years of financial analytics experience relating to measurement of costs and strong understanding of health care claims management and billing coding and analytics
Preferred Basic Qualifications:
- Provider, managed care experience
- Experience with analytic applications and groupers
- Clinical experience
- Master’s degree in business, healthcare or equivalent experience