Your Role

The Provider Partnerships and Network Management team support internal and external value-based processes including platform operations and reporting, vendor management support, and program and project management support for various new Health Reimagined, Provider Partnerships or other internal stakeholder solutions development within the value-based physician reporting and performance data platforms.

The Program Manager, Senior - Value Based Operations will report to the Senior Manager. In this role you will develop, manage, perform, organize, report, and streamline operational tasks that are part of value-based payment models. You will be the Platform Owner for the Value-Based Care team in the Pay for Care Agile Release Train. This will include providing the reporting to internal and external stakeholders including providers and their staff as well as supporting reporting and monitoring of value-based operations for problems, taking immediate action where possible and escalating when required. The role also interacts with stakeholders to resolve problems and provide information. The Program Manager, Senior is responsible for preparing for and organizing meetings by collecting and/or developing meeting materials including PowerPoint presentations, Excel reports, creating meeting agendas, documenting meeting notes, and tracking action item completion.

Your Work

In this role, you will:

• Become the subject matter expert on the payment models and the reporting from the platforms
• Schedule and coordinate sessions with new and existing practices on the payment models
• Manage annual updates to value-based models to ensure changes are approved, tested, implemented, then validated, including documentation and training
• Manage transition of value-based payment models into operations
• Develop, prepare, analyze, and present reports with complex analysis and data for management review
• Triage email box inquires and distribute to applicable departments for response as needed
• Prepare and distribute monthly files as part of new contracting process
• Research and answer internal questions related to attribution, care gap, quality, or other provider reporting data
• Serve as Product Manager for the Agile Release Train

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires a minimum of 5 years of prior relevant experience
• Requires experience in working cross-functionally in analyzing, designing, and developing business solutions
• Requires experience with managing work using agile/scrum
• Requires excellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, managers, and subject matter experts as well as external customers
• Scaled Agile (SAFe) certification: Product Owner/Product Manager (POPM), Scrum Master (SM), or Agile Product Management (APM) is preferred
• Prior experience in the health insurance industry is preferred
• Ability to problem solve with demonstrated ability to identify root cause of low complexity issues
• Ability to create "as-is" and "to-be" process flows and keep procedure manuals current
• Ability to function independently and produce results that meet standards of quality, timeliness, and acceptability
• Requires advanced skills using Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management
• Requires experience using SharePoint and project tracking tools such as Jira

Pay Range:

The pay range for this role is: $ 87,230.00 to $ 130,900.00 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.