Resp & Qualifications

Join us at CareFirst where we make a difference in our member's lives by fulfilling our mission to:

- Provide affordable and accessible health insurance to the plans insured and those persons insured or issued health benefit plans by affiliates or subsidiaries of the plan.

• Assist and support public and private health care initiatives for individuals without health insurance.

• Promote the integration of a health care system that meets the health care needs of all the residents of the jurisdictions in which the nonprofit health system service plan operates.

We are recruiting for a Director, Cost of Care join our Cost of Care and Vendor Management department within the Health Services division. This department focuses on improving affordability, accessibility, quality, and member satisfaction by working with the enterprise to define and administer new governance and operational models that optimize medical expense management. And this role will be integral to leading change at our company by aligning the strategy and resources required to define a multi-year medical expense savings portfolio, ensuring the projects listed in portfolio are delivered on-time, and finally, tracking and reporting on the collective quantitative results from the initiatives that have been implemented. This role is critical to enabling our enterprise plans and requires a candidate with a background with Finance, Analytics, Project Management and Change Management experience. Please see our core role definition and requirements listed below for additional details. Note: We are looking for an experienced people leader, primarily in the greater Baltimore/Washington DC metropolitan area, who is willing and able work in a remote model. The incumbent would be expected to work from their home, but also, be able to come on site to CareFirst locations based on business needs and work activities/ deliverables each week/month. This is not a 100% remote job and would require the ability to collaborate and work with colleagues and teams on premise.

If you are qualified and looking for a new role that will truly make a measurable difference, please reach out and apply.

PURPOSE:

Director, Cost of Care is responsible for the planning, governance and execution of the enterprise's end-to-end processes that identify, mitigate, and optimize medical expense savings opportunities on behalf of members and other stakeholders to improve affordability and accessibility of health care. Oversees Cost of Care Management through a data-driven savings process to achieve specific targets of incremental year-over-year improvement to medical expense. Collaborates with Health Services leaders across Provider Network / Value Based Care, Utilization Management and Case Management along with business leaders within Pharmacy, Product / Benefit Design, and Payment Integrity and Special Investigations to develop new ideas that drive savings opportunities and operational improvement. Working in close concert with the Finance division, this position will lead Cost of Care management process, including, but not limited to: target setting and reporting; ideation, vetting and selection; execution and performance monitoring and measurement. Develops short and long-term strategies to achieve cost of care-related goals and help align cost of care processes with internal functions such as Strategy and Planning, Innovation, and/or Product. Engages as an internal thought leader and support external partnership discussions.

ESSENTIAL FUNCTIONS:

• Ideation and Vetting/Selection Support: Leads business owners through ideation processes to develop new savings initiatives and the subsequent business case development in concert with Finance. Manages and curates ideas for CareFirsts cost of care savings portfolio to identify specific opportunities and general themes for further exploration and development. Aligns and maintains a formal set of stakeholder analysis meetings to evaluate the external impact of the cost of care portfolio, especially for new projects that may cause disruption. Ensures that business cases articulate maximized medical expense value, and an aligned view of operational impacts (ex: expenses, personnel, etc.) and revenue potential.

• Target Setting and Reporting: Works closely with Strategy & Planning, Actuarial, and Financial Planning & Analysis on annual and multi-year planning process and participating in target development and business case planning. Contributes to annual rate setting process with Finance, product, and business units as needed. Monitors and tracks progress of savings portfolio against enterprise and divisional plans. Oversees and facilitates tracking and report out of key performance indicators. Manages a technology platform that enables the collection, display, and management of cost of care ideas across the enterprise. Regularly updates leadership on the status of the Cost of Care process and portfolio and impact to corporate goals and directs the preparation of reporting and update-driven materials. Facilitates a regular cadence of cost of care process education and performance updates and present this information to the enterprise.

• Performance and Portfolio Management and Execution: Defines, prioritizes, and maintains a multi-year Cost of Care savings portfolio delineating all the activities being leveraged to achieve savings goals, from ideation to performance management. Partners with the Enterprise Project Management Office (EPMO) and Divisional resources to initiate and plan program/project activities and analysis and align portfolio management process with EPMO where appropriate. Assists in the implementation of divisional cost of care initiatives, and manage the execution effort by controlling scope, budget, schedule, quality, risk, compliance, etc. in accordance with requirements. Manages and provides portfolio status updates to leadership and key stakeholders; ensures key milestones and portfolio momentum are achieved; and assists in highlighting and mitigating portfolio risks. Contributes to strategic planning related to the business architecture required to support the portfolio and contributes to quality assurance on major deliverables. Serves as a Cost of Care champion throughout the enterprise and ensures that Health Services employees and other internal stake holders understand and support the goals and processes of cost of care management.

• Talent Management and Budget Oversight: Directs the strategic and the day-to-day activities of the Department, including coaching and guiding individuals and teams in order to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.

• Market Intelligence & Analysis: Gathers market intelligence to understand best practices in cost of care management, monitoring emerging trends among payer, physicians, hospitals, and ancillary providers. Drives the definition, implementation and adoption of analytics, benchmarks, and insights to understand effectiveness of current practices and identify new opportunities to address the major drivers of health care expenditure. Interfaces with external consultants and industry thought leaders to understand rapidly changing market dynamics and find new savings and improvement opportunities. Stays apprised of the state and industry healthcare landscape and incorporate new developments or opportunities, as well as competitive and operational threats, into the governance process. Coordinates research and insight from internal and external resources to inform horizon scanning and focus area prioritization.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Health Care Administration, Business Administration, Finance, Information Management, Public Health, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience:

• 8 years of progressive responsibility in a healthcare operational environment. In addition, must have experience in cost of care trend analytics.

• 3 years management experience.

Preferred Qualification:

• Masters Degree in Health Care Administration, Business Administration, Finance, Information Management, Public Health, or related field.

• Working knowledge of both Commercial and Government programs lines of business.

• Experience within a health plan/payer organization.

• Expertise with delivering on process improvement and savings processes, as well as defining and executing business strategies.

• Exposure to large-scale governance and change, including examples such as business transformation, project/program management, strategic planning development and corporate initiative implementation.

Knowledge, Skills and Abilities (KSAs)

• Successful track record of creating new data-driven services and operational capabilities across extensive and varied scope of impact.

• Independent and strategic thinking, with strong, self-driven abilities to obtain information, develop plan, obtain consensus, and monitor progress in team-driven environments.

• Financial modeling, business case development, team/work effort organization, strategic planning, project delivery, portfolio management, change management and analytical skills.

• Ability to communicate credibly and effectively across all levels of the organization, including experience in communicating across large teams including senior executives.

• Understanding of health plan financial data, health care claims data, trend analysis, and insurance operations and products.

• Understanding of product development, provider payment policies, clinical programs, care management or other clinical and administrative functions.

• Demonstrated ability to establish effective, collaborative relationships.

• Demonstrated effectiveness in leading effectively both matrixed and directly supervised functions. Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.

• Experience in Microsoft Office applications.

• Proven ability to make timely decisions in a fast-paced high-pressure environment.

• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $144,000 - $267,300

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Cost of Care and Vendor Management Department within Health Services Division

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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REQNUMBER: 19565