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At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
This position will lead all aspects of Capital’s network contracting activities related to value-based reimbursement methodologies for the network portfolio, including facility and professional providers. Responsible for direct oversight, management, and training of the contracting staff reporting to this position. Responsible for the negotiation of contract terms, program features, and implementation of strategic network-inspired program designs. Leads the transformation of Capital’s existing network from a primarily fee-for-service driven model to a model of value-based programs that align with the Triple Aim objectives (satisfaction, quality, and cost). The individual will manage and oversee complex projects related to provider networks, reimbursement methodologies, program performance management/governance, and the contractual/statutory/regulatory requirements necessary to ensure compliance with such items as network adequacy etc. Must be able to assess budgeting and forecasting initiatives for inclusion of Value Based provider contracts. Oversees analysis of claim trend data and/or market information to drive conclusions to support program performance and contract negotiations. Leads all value-based program governance activities and builds a culture of cross-functional expertise to empower stronger relationships and performance outcomes. Additionally, this individual will have the ability to represent the Senior Director and/or Vice President in work groups and in communicating departmental, provider partner, and other needs as identified
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Full Time
Insurance
$152k-202k (estimate)
05/19/2024
05/29/2024
capbluecross.com
HARRISBURG, PA
1,000 - 3,000
1938
TODD A SHAMASH
$500M - $1B
Insurance
Find all of our current job openings at capbluecross.com/careers. We're a Harrisburg, Pa.-based health insurer dedicated to improving the health and well-being of our community. Our focus is on tangible results for our customers in Central Pennsylvania and the Lehigh Valley, offering group and individual insurance, health and wellness support, and so much more. Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley.