Your Role

The Payment Innovation team leads the design, development, and implementation of value-based payment models. The Program Manager, Principal - Payment Innovation will report to the Senior Manager of Payment Innovation. In this role you will be responsible for leading the end-to-end design of new value-based payment models that support Blue Shield's strategic goals. He/she/they will manage program(s) from initiation through delivery, perform operational responsibilities, and monitor for continuous improvement.

Your Work

In this role, you will:

• Operate at a strategic business level to ensures projects/programs are in line with Blue Shield of California strategic goals
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement multiple and extremely complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Designs and implements value-based payment models/payment mechanisms spanning across business areas where analysis requires evaluation of intangible variance factors.
• Conducts market research and literature review on alternative payment models and clinical redesign efforts
• Services as an internal central point of conduct for their assigned topic of transformation work with providers
• Manage project/program planning to ensure completion of key deliverables and reporting
• Lead cross functional project teams, including defining meeting agenda, lead meetings, capture meeting notes and follow-up on action items

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires previous experience in designing a program/initiative end-to-end, including conceptual design, implementation planning and execution, and on-going operational support
• Requires significant knowledge and experience of health insurance business and structure, preferably within a payor
• Requires significant experience with aligning disparate stakeholders
• Previous experience in value-based care design including designing value-based payment models or financial models preferred
• Experience with payor data infrastructure, regulations for various lines of business and contracting preferred

Pay Range:

The pay range for this role is: $136400.00 to $ 204600.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.