Director Solution Design & Reimbursement

About Blue Cross

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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 Director of Product Solution Design and Reimbursement leads teams that support the enterprise's affordability programs.

This includes developing a team whose craft is identifying, evaluating, and designing potential affordability initiatives along with associated business cases, and helping to manage their review / approval to successfully deliver savings and / or other value to Blue Cross and its customers and to ensure appropriate care to members.

The director will also be responsible for supporting reimbursement policy and will work in partnership with product managers across Medical Management to achieve their sustainability goals.

The director will have a dedicated team comprised of individuals who research / analyze and develop concepts, approaches and business cases for affordability.

This position is a key member of the Population Health and Affordability management team and leads the optimization of affordability initiatives.

A Day in the Life : Ensures the goals, scope, objectives of the program are clearly defined and agreed upon by applicable governance committees.

Develops a team to support divisional affordability concept design and evaluation efforts to achieve enterprise and divisional strategic priority efforts.

Ensures the pipeline development process includes P&L owner input and needs.Develops / manages standardized reporting for the program including pipeline process / progress, business cases, economic / value impact, implementation status, etc.

Oversight of reimbursement policy team.In partnership with the Performance Evaluation Team, assesses and monitors overall program performance metrics including total financial savings, ROI and / or Return on Value for specific initiatives.

Ensures timely implementation of population health or affordability savings / value to keep results in line with business case expectations for timing, resource requirements and ROI.

Is responsible for tracking and deliverables, including concept development, evaluation and business case development (including deep dives to ensure enterprise stakeholder input and alignment) as required per initiative.

Directs professional staff dedicated to the program and guides the work for committee review.Attracts, selects, and motivates a best-in-class team of professionals and provides them with the tools, platforms and processes necessary to be effective.

Conducts regular status updates and initiative reviews with VP and business owners, facilitating discussions to identify and resolve issues and obtain alignment on required decisions via governance or other meetings as appropriate.

Ensures that all aspects and methodologies of successful program design are followed appropriately, and also ensures close alignment with program execution team partners to identify / plan for implementation.

This includes charters, concept briefs, deep dive materials, business cases, etc. as applicable.Acts as the key focal point for all questions, submission and analytics related to affordability program design.

Directs the affordability business unit including interviewing and hiring associates following required EEO and Affirmative Action guidelines and ensuring associates receive the proper training.

Conducts performance evaluations, and is responsible for managing associates, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

Nice to Have : Direct experience working on population health and / or affordability programs interventions.Bachelor's or MBA / Master’s degree in public health or related field.

Previous experience working within Blue Cross and Blue Shield of Minnesota.Experience with community health, health equity or similar functions.

Strategy development experience, which includes creating / implementing a long-range strategic plan which could potentially address, among other things, assessment of competitors, identification of priorities, articulation of what will be needed to achieve the plan and associated measures of success, and sequencing of activities to maximize outcomes.

Ability to easily toggle between the strategic perspectives required and the tactical level required at the individual contributor and initiative level.

Required Skills & Experiences : Accepting this director level position at BCBSMN requires signing an Associate Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.

7 years of related professional experience, with 3+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

At least 5 years of relevant health care experience.People leadership experience that includes either direct staff management, cross functional team leadership, or both.

Experience in identifying, developing, assessing and designing new healthcare program concepts / programs / interventions that are time sensitive in a matrixed reporting and accountability situation.

Demonstrated ability to develop collaborative relationships with key stakeholders within the organization, including earning the respect of senior executives within the organization.

Strong written and oral communication skills and experience presenting complex information to leadership in an organization.

Demonstrated ability to make tough, critical and prioritization decisions to drive toward the greatest opportunity and / or address shifting organizational priorities.

Demonstrated ability to effectively manage and achieve results in a matrixed organizational structure.Demonstrated creativity and problem-solving skills that demonstrate flexibility, adaptability and resolve.

Resiliency : ability to adapt and thrive in a fast paced, exacting environment.Make A DifferenceBlue 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 talent.

[email protected] 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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