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July 8, 2010
Director, Public Programs (Healthcare Economist): BlueCross BlueShield
Location: Chattanooga, Tennessee, USA
The incumbent will serve in a pivotal position on the Government Business and Emerging Markets (GBEM) team. This senior member of the Federal Programs team is responsible for enhancing the enterprise’s efforts related to the research, development, introduction and operational implementation of solutions in the public (federal and state) health care space, as well as furnishing consulting services related to coordination of efforts within the Government Business and Emerging Markets and Commercial and Existing Business Markets Divisions. This will include efforts related to several wholly owned subsidiaries and public-oriented enterprise investments that are not wholly-owned. The ideal candidate will have a progressive and highly visible track record of accomplishment in the areas of planning, business development, industry relations, communications, team and consensus building financial analysis and regulatory compliance. The incumbent must possess a thorough knowledge of public health insurance and delivery programs including extensive familiarity with the payment methodologies, regulatory environment and related processes. The incumbent may be directly involved in the assessment, development, implementation or enhancement of new business alliances or acquisitions involving the enterprise’s public programs. She/he will be instrumental in conducting research, modeling, performing impact analysis and assisting in the review of information that will translate into products and programs for older adults, children and other public program participants, the professionals that serve them and the payers that authorize the programs.
As such he/she is responsible for coordinating with GBEM leadership including the President, GBEM, GBEM Chief of Staff, the GBEM Market Strategist and product specific leads to identify and create opportunities for the enterprise to position itself with either unsolicited or responsive solutions to market opportunities. The incumbent will also have the opportunity to lead certain start-up initiatives through to implementation.
Job Duties & Responsibilities
- Support the President, GBEM, Senior Vice President, Federal Programs and GBEM leadership to achieve the goals set forth for the government lines of business.
- Coordinate the design, development, quantification, implementation, interpretation and management of the enterprise support needs for providing useful, actionable information that supports GBEM and enterprise.
- Directs and coordinates research and development activities for organizational products, services, or ideologies: Plans and formulates aspects of research and development proposals.
- Develops and implements methods and procedures for monitoring projects, for example preparation of records of expenditures and research findings, progress reports, implementation/project plans, and resource assessment.
- Contribute to the development, configuration, implementation of the health benefits and care management systems in support of public programs.
- Develop recommendations regarding new programs to meet the Centers for Medicare and Medicaid Services, Veteran’s Affairs, military health services, state and other public health program requirements.
- Provide assistance in financial model development, oversight and reporting to Enterprise for the Medicare , Medicaid and other public program oriented lines of business.
- Assist the Federal programs Group in planning and positioning for future expansion of its role in financial integrity activities in support of public programs.
- Provide project direction, development and management for GBEM to ensure market competitiveness and responsive product development and placement.
Job Qualifications
Education
- Master’s degree in business, health care or related field required
Experience
- 10+ years experience in the health insurance industry required
- Proven management responsibility with 15+ years health economics experience in managing projects with a successful level of achievement in public programs or programs geared toward seniors, veterans or disabled populations
- Previous experience budgeting and estimating resources needs for operational activities
- Previous experience creating, leading and supervising departments with successful performance outcomes in public programs including the ability to identify key strategic performance measures for success
- Demonstrates proficiency in health economics analysis and modeling
- Demonstrates understanding of statistics, health services research and the ability to apply the principles, concepts, practices and standards related to health economics and reimbursement.
Skills/Certifications
- Demonstrated proficiency in navigating the regulatory and economic demands of public programs
- Thorough knowledge and understanding of state and federal programs and related requirements such as Medicare and Medicaid
- Direct experience in negotiating or presenting materials or programs to or on behalf of government entities
- Proficiency in project management, problem solving, solution development and implementation
- Proven ability to capitalize upon business relationships and coordinate multiple divisional interfaces and capabilities
- Proven experience with incorporating public healthcare program requirements into program design and operation
- Innovative demonstration of quality, change, and culture management techniques that demonstrate mastery of communication and motivation skills
- Superior analytical ability to independently interpret processes into performance indicators and outcomes resulting in innovative, successful projects.
- Proven evidences of successful independent customer relations management
- Past experience managing outcomes research, econometrics and data analytics
To apply: http://www.bcbst.com/about/careers/
