Principal Strategic Advisor, Healthcare
About the position
In this role, you will lead efforts to achieve innovation-based goals through new forms of healthcare reimbursement, healthcare redesign consultation, payer/provider engagement, and market offer opportunities. You will leverage your extensive industry experience and expertise to promote enterprise understanding of the key areas in which the company is seeking to create competitive differentiation and establish a sustainable competitive advantage in the marketplace. Your primary focus will be on proactively identifying, evaluating, and leading the implementation of Risk Adjustment strategic initiatives, provider reimbursement, and partnership strategies to meet Blue Cross Blue Shield of North Carolina's (BCBSNC) growth objectives. This includes managing healthcare costs while improving outcomes and the healthcare experience for our members. You will support and manage development efforts related to the enhancement and maintenance of our current products and market offer components. Leading critical activities such as strategic planning, highly complex quantitative and qualitative analysis, and thought leadership at both departmental and enterprise levels will be essential. You will present information such as strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics, and impact assessments to both internal and external audiences at all levels, including senior-level leadership. Additionally, you will organize, optimize, and communicate progress towards the completion of the overall work portfolio. Collaboration with and support for other departments across the enterprise on both common initiatives and unique ventures will be a key part of your role, acting as a subject matter expert for healthcare delivery transformation and/or healthcare reimbursement and strategy. You will also identify, analyze, and monitor industry, regulatory, technology, and market-based trends that affect divisional operations, provider reimbursement, medical expense strategy, and overall payer-provider dynamics. Utilizing your extensive expertise, you will identify and drive operational improvements with new analysis/reporting capabilities, project management techniques, and/or consulting/engagement approaches. Furthermore, you will serve as a mentor and coach to more junior team members regarding various skills and approaches and may oversee the work of other staff members as needed.
Responsibilities
Proactively identify, evaluate and lead the implementation of Risk Adjustment strategic initiatives, provider reimbursement and partnership strategies.
,
Support and manage development efforts related to the enhancement and maintenance of current products and market offer components.
,
Lead strategic planning, complex quantitative/qualitative analysis and thought leadership at departmental and enterprise levels.
,
Present strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics and impact assessments to internal and external audiences.
,
Organize, optimize and communicate progress towards the completion of overall work portfolio.
,
Collaborate with and support other departments on common initiatives and unique ventures, acting as a subject matter expert.
,
Identify, analyze and monitor industry, regulatory, technology and market-based trends affecting divisional operations and provider reimbursement.
,
Drive operational improvements with new analysis/reporting capabilities, project management techniques and consulting/engagement approaches.
,
Serve as a mentor and coach to junior team members and oversee their work as needed.
Requirements
Bachelor's degree or advanced degree (where required)
,
8+ years of experience in related field
,
In lieu of degree, 10+ years of experience in related field
Nice-to-haves
Prior Risk Adjustment Operational/Analytical experience
,
Knowledge of MA and ACA Risk Adjustment Models
Benefits
Competitive health benefits
,
Bonus plans based on performance
,
401(k) with employer match
,
Paid time off (plus two well-being days)
,
Career development programs
,
Wellness programs
Apply Now
In this role, you will lead efforts to achieve innovation-based goals through new forms of healthcare reimbursement, healthcare redesign consultation, payer/provider engagement, and market offer opportunities. You will leverage your extensive industry experience and expertise to promote enterprise understanding of the key areas in which the company is seeking to create competitive differentiation and establish a sustainable competitive advantage in the marketplace. Your primary focus will be on proactively identifying, evaluating, and leading the implementation of Risk Adjustment strategic initiatives, provider reimbursement, and partnership strategies to meet Blue Cross Blue Shield of North Carolina's (BCBSNC) growth objectives. This includes managing healthcare costs while improving outcomes and the healthcare experience for our members. You will support and manage development efforts related to the enhancement and maintenance of our current products and market offer components. Leading critical activities such as strategic planning, highly complex quantitative and qualitative analysis, and thought leadership at both departmental and enterprise levels will be essential. You will present information such as strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics, and impact assessments to both internal and external audiences at all levels, including senior-level leadership. Additionally, you will organize, optimize, and communicate progress towards the completion of the overall work portfolio. Collaboration with and support for other departments across the enterprise on both common initiatives and unique ventures will be a key part of your role, acting as a subject matter expert for healthcare delivery transformation and/or healthcare reimbursement and strategy. You will also identify, analyze, and monitor industry, regulatory, technology, and market-based trends that affect divisional operations, provider reimbursement, medical expense strategy, and overall payer-provider dynamics. Utilizing your extensive expertise, you will identify and drive operational improvements with new analysis/reporting capabilities, project management techniques, and/or consulting/engagement approaches. Furthermore, you will serve as a mentor and coach to more junior team members regarding various skills and approaches and may oversee the work of other staff members as needed.
Responsibilities
Proactively identify, evaluate and lead the implementation of Risk Adjustment strategic initiatives, provider reimbursement and partnership strategies.
,
Support and manage development efforts related to the enhancement and maintenance of current products and market offer components.
,
Lead strategic planning, complex quantitative/qualitative analysis and thought leadership at departmental and enterprise levels.
,
Present strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics and impact assessments to internal and external audiences.
,
Organize, optimize and communicate progress towards the completion of overall work portfolio.
,
Collaborate with and support other departments on common initiatives and unique ventures, acting as a subject matter expert.
,
Identify, analyze and monitor industry, regulatory, technology and market-based trends affecting divisional operations and provider reimbursement.
,
Drive operational improvements with new analysis/reporting capabilities, project management techniques and consulting/engagement approaches.
,
Serve as a mentor and coach to junior team members and oversee their work as needed.
Requirements
Bachelor's degree or advanced degree (where required)
,
8+ years of experience in related field
,
In lieu of degree, 10+ years of experience in related field
Nice-to-haves
Prior Risk Adjustment Operational/Analytical experience
,
Knowledge of MA and ACA Risk Adjustment Models
Benefits
Competitive health benefits
,
Bonus plans based on performance
,
401(k) with employer match
,
Paid time off (plus two well-being days)
,
Career development programs
,
Wellness programs
Apply Now