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VP Medicare Stars Center of Excellence VP Medicare Stars Center of Excellence Job

Company name
Blue Cross and Blue Shield of Minnesota

Location
Eagan, MN

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For more than 80 years, Blue Cross and Blue Shield of Minnesota has been passionate about improving health. We provide quality, cost-effective health plans and innovative programs that make a healthy difference in people\u2019s lives. Blue Cross is the largest health plan based in Minnesota, covering nearly 3 million members in the state and across the country. We strive to help all Minnesotans overcome the barriers to good health. We offer our employees a comprehensive benefits, compensation and total rewards package to keep you and your family healthy and to secure your financial future. Our Employee Resource Groups help us advance health equity while promoting a diverse and inclusive work environment. Join us and make a healthy difference in people\u2019s lives through the work you do every day. Together, we'll make Minnesota a better place to live \u2014 and a healthier one. Description Summary The VP of the Center of Excellence for Star and Risk Adjustment is responsible for leading enterprise development of the Medicare Star, ACA Quality Rating System, and Enterprise Risk Adjustment strategy. The incumbent drives cross-divisional execution of a multi-year strategy to achieve and maintain a Star rating of 4 , and revenue optimization in all enterprise risk adjustment activities. Development of the Center of Excellence strategy includes integrating the Star and Risk Adjustment approach to 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 includes 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, data and analytics, grievance and appeal management, and customer service to drive successful integration with the Center of Excellence 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. Accountabilities 1) Lead enterprise efforts to maximize the Medicare CMS Star rating, ACA Quality Rating System, and optimize risk-adjusted revenue in all risk-adjusted market segments. Develop a multi-year strategy in collaboration with organizational stakeholders including Health Care Management, Member Services, Network Operations, 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, and risk-adjustment activities. 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 and ACA programs. 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, revenue, 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. Requirements Accepting this position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment. Bachelor degree in business, health care administration, health policy or other relevant discipline, plus 7 years of Medicare managed care experience. \u00b7 Minimum of 5 years of direct people leadership experience. \u00b7 Demonstrated leadership ability exemplified by: a capacity to think strategically and implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration \u00b7 an ability to develop and lead high performance and collaborative teams. \u00b7 Achievement of results through collaboration with divisions across large, complex organizations, and \u00b7an ability to organize and manage multiple priorities and budgets. \u00b7 \u00b7 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. \u00b7 These key values are: Respect, Accountability, Imagination, and Courage. \u00b7 \u00b7 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 \u00b7 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. \u00b7 Preferred Requirements Master\u2019s degree in business, health care administration, health policy or other relevant discipline FLSA Status Exempt 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. Make a difference Thank you for your interest in Blue Cross. Be part of a company that lets you be you \u2014 and make a healthy difference in people\u2019s lives every day Blue 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, or any other legally protected characteristic. Blue Cross\u00ae and Blue Shield\u00ae of Minnesota and Blue Plus\u00ae are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Company info

Blue Cross and Blue Shield of Minnesota
Website : http://www.bluecrossmn.com

Company Profile
Our history began in 1933, when seven St. Paul hospitals teamed up to form the “Minnesota Hospital Association.” It became the country’s first prepaid health care network. An early ad featured a nurse with a blue cross armband on the sleeve of her uniform. This was the birth of our iconic logo. We became the first health plan to be known as “Blue Cross.” Less than 10 years later, the name and symbol were adopted by the national Blue Cross Association. Blue Cross went on to become one of most recognized and trusted health care brands in the world.

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