VP Medicare Stars Center of Excellence (Job Number:11338)
Description
Summary:
The VP of the Medicare Star Center of Excellence is responsible for leading enterprise development of the Medicare Star strategy and driving cross-divisional execution of a multi-year strategy to achieve and maintain a Star rating of 4+. Development of the Medicare Star strategy will include provider engagement, payment and risk sharing models, collaborative care models, data/analytics support, member engagement, health improvement and management programs and collaboration with vendor partners to achieve identified goals. Operational integration will include coordination with impacted divisions within Blue Cross to ensure support and coordination with existing health plan programs and functions including medical management, claims payment, consumer experience, product development, network management, revenue optimization, data and analytics, grievance and appeal management, and customer service to drive successful integration with the Medicare Star strategy.
The Vice President will work in close collaboration with executive leadership of Blue Cross representing Medical Affairs, Health Economics, Integrated Health Management, Sales, Product Development, Underwriting, Actuarial, Finance, Network Management, Government Programs, Operations and other divisions. The role may involve interaction with leadership of integrated delivery systems, hospitals, clinics, and other health care provider organizations, and with trade associations. Other key external relationships will be with the Blue Cross and Blue Shield Association and other Blue Cross Blue Shield plans.
Accountabilties:
1. Lead efforts to maximize the Medicare CMS STAR rating. Develop a multi-year strategy in collaboration with organizational stakeholders including Health Care Management, Member Services, Network Operations, Revenue Optimization and other business units as necessary to drive process change across the organization to improve performance.
2. Develop roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective. Collaborate with analytics team to measure the effectiveness of initiatives and process improvements.
3. Coordinate with existing vendors, and/or identify and implement new vendors, in order to drive desired outcomes in quality-based metrics.
4. Coordinate activities of Star improvement and risk adjustment/revenue optimization such that maximum benefit is derived with minimized provider and member abrasion.
5. Lead, coach, and instruct process owners and improvement teams in the definition, documentation, measurement, improvement, and control of processes aimed at optimizing the quality of the Medicare program.
6. Create and lead cross-departmental initiatives to change processes such that members experience improved satisfaction with the health plan and are less inclined to dis-enroll.
7. Evaluate the effectiveness of existing operational metrics, developing new metrics as necessary, to better assess the performance of organization in achieving quality and satisfaction targets.
8. Gather member experience data and conduct analysis to identify gaps, opportunities and performance trends.
9. Partner with all appropriate business units, including but not limited to, Health Care Management, Business Improvement, Compliance, and Member Services to understand and explain trends that are driving member behavior. Utilize this information to assist senior leadership in making strategic business development decisions.
10. Track and report on initiative progress at all appropriate levels of the organization; creating or joining the necessary forums to do so.
11. Directs the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
• Work is performed in an office setting
• In-state and out-of-state travel occasionally required
• Required travel between Eagan campus building locations
Qualifications
Required Qualifications:
- Accepting this position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- The successful candidate will possess a bachelor degree in business, health care administration, health policy or other relevant discipline, plus 10 + years of Medicare managed care experience.
- Minimum of 10 years of direct people leadership experience.
- The position requires an individual who has demonstrated leadership ability exemplified by:
- a capacity to think strategically and implement tactically to consistently deliver results;
- well-developed skills in diplomacy and collaboration
- an ability to develop and lead high performance and collaborative teams. Achievement of results through collaboration with divisions across large, complex organizations, and
- an ability to organize and manage multiple priorities and budgets.
- An ability to lead people and get results through others.
- Excellent communication, interpersonal and presentation skills.
- Strong analytical and operations management skills are essential, and must include the ability to provide guidance to technical staff.
- Candidates should possess the executive presence and expertise necessary to be viewed with confidence by staff, senior leadership, external providers and accounts and the board, as the individual who can ensure that Blue Cross' investment in its Provider Collaboration function will be highly beneficial for the organization.
- Candidates must possess the highest ethical standards and share the organization's commitment to the key values under which it operates. These key values are: Respect, Accountability, Imagination, and Courage.
- Excellent relationship skills to partner on shared goals with other Blue Cross teams and colleagues. Seasoned judgment, problem analysis and resolution skills.
- Confident decision making skills in a fluid, dynamic company and rapidly industry environment
- Management skills which demonstrate the ability to organize and manage multiple priorities and budgets.
- Excellent communication, interpersonal and presentation skills.
- Excellent relationship skills to partner on shared goals with other Blue Cross teams and colleagues as well as with external key influencers.
Preferred Qualifications:
- Master’s degree in business, health care administration, health policy or other relevant discipline
Blue Cross Blue Shield of Minnesota 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, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
The VP of the Medicare Star Center of Excellence is responsible for leading enterprise development of the Medicare Star strategy and driving cross-divisional execution of a multi-year strategy to achieve and maintain a Star rating of 4+. Development of the Medicare Star strategy will include provider engagement, payment and risk sharing models, collaborative care models, data/analytics support, member engagement, health improvement and management programs and collaboration with vendor partners to achieve identified goals. Operational integration will include coordination with impacted divisions within Blue Cross to ensure support and coordination with existing health plan programs and functions including medical management, claims payment, consumer experience, product development, network management, revenue optimization, data and analytics, grievance and appeal management, and customer service to drive successful integration with the Medicare Star strategy.
The Vice President will work in close collaboration with executive leadership of Blue Cross representing Medical Affairs, Health Economics, Integrated Health Management, Sales, Product Development, Underwriting, Actuarial, Finance, Network Management, Government Programs, Operations and other divisions. The role may involve interaction with leadership of integrated delivery systems, hospitals, clinics, and other health care provider organizations, and with trade associations. Other key external relationships will be with the Blue Cross and Blue Shield Association and other Blue Cross Blue Shield plans.
Accountabilties:
1. Lead efforts to maximize the Medicare CMS STAR rating. Develop a multi-year strategy in collaboration with organizational stakeholders including Health Care Management, Member Services, Network Operations, Revenue Optimization and other business units as necessary to drive process change across the organization to improve performance.
2. Develop roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective. Collaborate with analytics team to measure the effectiveness of initiatives and process improvements.
3. Coordinate with existing vendors, and/or identify and implement new vendors, in order to drive desired outcomes in quality-based metrics.
4. Coordinate activities of Star improvement and risk adjustment/revenue optimization such that maximum benefit is derived with minimized provider and member abrasion.
5. Lead, coach, and instruct process owners and improvement teams in the definition, documentation, measurement, improvement, and control of processes aimed at optimizing the quality of the Medicare program.
6. Create and lead cross-departmental initiatives to change processes such that members experience improved satisfaction with the health plan and are less inclined to dis-enroll.
7. Evaluate the effectiveness of existing operational metrics, developing new metrics as necessary, to better assess the performance of organization in achieving quality and satisfaction targets.
8. Gather member experience data and conduct analysis to identify gaps, opportunities and performance trends.
9. Partner with all appropriate business units, including but not limited to, Health Care Management, Business Improvement, Compliance, and Member Services to understand and explain trends that are driving member behavior. Utilize this information to assist senior leadership in making strategic business development decisions.
10. Track and report on initiative progress at all appropriate levels of the organization; creating or joining the necessary forums to do so.
11. Directs the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
• Work is performed in an office setting
• In-state and out-of-state travel occasionally required
• Required travel between Eagan campus building locations
Qualifications
Required Qualifications:
- Accepting this position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- The successful candidate will possess a bachelor degree in business, health care administration, health policy or other relevant discipline, plus 10 + years of Medicare managed care experience.
- Minimum of 10 years of direct people leadership experience.
- The position requires an individual who has demonstrated leadership ability exemplified by:
- a capacity to think strategically and implement tactically to consistently deliver results;
- well-developed skills in diplomacy and collaboration
- an ability to develop and lead high performance and collaborative teams. Achievement of results through collaboration with divisions across large, complex organizations, and
- an ability to organize and manage multiple priorities and budgets.
- An ability to lead people and get results through others.
- Excellent communication, interpersonal and presentation skills.
- Strong analytical and operations management skills are essential, and must include the ability to provide guidance to technical staff.
- Candidates should possess the executive presence and expertise necessary to be viewed with confidence by staff, senior leadership, external providers and accounts and the board, as the individual who can ensure that Blue Cross' investment in its Provider Collaboration function will be highly beneficial for the organization.
- Candidates must possess the highest ethical standards and share the organization's commitment to the key values under which it operates. These key values are: Respect, Accountability, Imagination, and Courage.
- Excellent relationship skills to partner on shared goals with other Blue Cross teams and colleagues. Seasoned judgment, problem analysis and resolution skills.
- Confident decision making skills in a fluid, dynamic company and rapidly industry environment
- Management skills which demonstrate the ability to organize and manage multiple priorities and budgets.
- Excellent communication, interpersonal and presentation skills.
- Excellent relationship skills to partner on shared goals with other Blue Cross teams and colleagues as well as with external key influencers.
Preferred Qualifications:
- Master’s degree in business, health care administration, health policy or other relevant discipline
Blue Cross Blue Shield of Minnesota 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, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job