Value Based Program Administrator

Summary
 We are currently hiring for a Value Based Program Administrator to join BlueCross BlueShield of South Carolina. In this role as Value Based Program Administrator, you will provide program operation, coordination, and analysis of various value-based reimbursement programs. You will work strategically with internal stakeholders including management, finance, and other areas to identify, analyze, determine, and improve programs initiatives and products that facilitate driving an increasing percentage of payment for value. You will also actively engage, establish, and maintain positive relationships with external stakeholders to include physician practices, health systems, and clinicians.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Description
 

Logistics:

This position is full time (40 hours/week) Monday-Friday and will be fully remote (W@H) with a flexible work arrangement to work onsite at 4101 Percival Road, Columbia, S.C., 29219 as needed.

What You Will Do:

• Primary contact for implemented value-based initiatives.
• Works with physicians, clinical leadership, and management to identify/prioritize value-based opportunities.
• Utilizes internal/external data to identify savings opportunities.
• Helps to design and measure the success of value-based initiatives using reimbursement, contracting data and other internal financial sources.
• Works closely with reporting areas to obtain data and make evaluations.
• Keeps senior leadership informed of recommendations and identified savings opportunities.
• Provides supportive quantitative summary analysis to help lead the discussion for the assessment of clinical and financial implications of product decisions.
• This includes working with actuary, I/S, finance, and other areas of the company as needed (e.g., commercial, Medicare Advantage, Exchange, etc.).
• Continuously track value-based efforts measuring and documenting quality and service success.
• Assist senior management with the development of new networks and accountable care organizations and assist with the monitoring of the networks for adequacy.
• Assist with recruitment and contracting as needed.
• Remain current on new valued-based trends, tools and best practices and communicate those to leadership/teams.
• Creates educational material to support valued-based initiatives for internal/external stakeholders, provider community, internal policy and procedures ensuring all materials are current and accurate.
• Assist in coordination of educational programs as appropriate for program development.
• Maintains a working knowledge of current and proposed healthcare quality initiatives and requirements from internal departments and State/Federal agencies.

To Qualify for This Position, You Will Need:

• Bachelor's degree in related healthcare field such as Healthcare Administration, Business Administration, OR job-related field.
• Four years equivalent job-related work experience in health care systems, including leadership or coordination of programs, quality or operations, OR four years of value-based reimbursement experience in a health plan or health care system.
• Four years of relevant work experience in a health care system or health plan, including leadership or coordination of programs, quality improvement, analysis, or operations.
• Strong communication, interpersonal, organizational, and facilitation skills, to include the ability to negotiate and resolve conflicts. 
• Attention to detail and follow-through.
• Analytical and quantitative skills including data gathering, organization, assessment, reporting, and presentation.
• Previous experience in product evaluation, contract conversion, standardization, and analysis of utilization.
• Experience with value-based reimbursement programs.
• Demonstrated skills related to training materials developments.
• Analytical and critical thinking skills.
• Microsoft Office.
• Excel.

What We Prefer:

• Bachelor's degree in healthcare administration.
• Four years of experience in a value based analytical environment with healthcare environment.
• Advanced Excel skills.

What We Can Do for You:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave – the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Incentive Plan
• Merit Plan
• Continuing education funds for additional certifications and certification renewal

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.