Job Information
Blue Cross and Blue Shield of Louisiana SVP, Health Services in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
Job Summary/Position Purpose:
The Senior Vice President, Health Services is responsible for developing and executing the company’s provider network and pharmacy benefit strategy that meet objectives for quality, member access, cost performance and trend management. They are responsible for executing strategies across lines of business, developing reimbursement and incentive based payment models to enhance quality and efficiency. They are also responsible for executing the company’s strategy for improving health, experience and affordability of care.
How You Contribute to the Company’s Mission in this Role:
The position oversees all provider network, healthcare value management, and pharmacy functions of the company and in that capacity has overall responsibility for managing the total cost of care for members and customers.
Guide the development of provider networks that support Plan’s product portfolio and provide the appropriate level of access and reimbursement to ensure Plan’s products are competitive.
Works cross functionally to develop network strategies, articulate risk arrangements and monitor network and contracting functions to support the strategic direction of the company.
Aligns the execution of both short-term tactical initiatives and long-term strategies to facilitate the organization’s ability to meet or exceed operating annual medical cost budgets and Medical Loss Ratio (MLR) targets.
Develop programs and services to guarantee a high level of provider satisfaction and corporate efficiencies related to provider network management and electronic claims and inquiries.
Oversee the implementation of strategies, policies, and procedures that promote cost reduction and/or quality improvement efforts related to pharmacy benefit management.
Provides oversight of Blue Cross and Blue Shield’s contracted PBM vendor for the purpose of ensuring contractual compliance and accurate claims adjudication
Specific areas of responsibility include: Pharmacy management, and management of the pharmacy benefit management vendor relationship, Provider network management functions, including provider reimbursement, value-based payment programs (alternative payment models), provider credentialing & contracting, provider relations, payment integrity, and network operations (e.g. provider data management, EDI, etc.), Health care value transformation and payment innovation, and Care delivery, including eleHealth subsidiary.
Provides support, guidance and coordination across the organization on matters that both impact and depend on the health services division, including Sales and Marketing, Product Development, Medical Policy, Care Management, Quality, Claims Administration, Customer Service, Finance, Actuarial and Underwriting, Legal, and Human Resources. Complies with all laws and regulations associated with duties and responsibilities.
Required Qualifications:
Bachelor’s degree in business administration, accounting or a related field. Four years of related experience can be used in lieu of a bachelor’s degree.
10 years of leadership experience in healthcare or related environment.
7 years of experience negotiating and executing contracts in payer and/or provider organizations, including leading complex contract negotiations.
Experience writing, editing, and developing complex contractual documents.
Strong interpersonal skills and financial acumen with a comprehensive understanding of contractual options and healthcare economics.
Legal knowledge to facilitate communication with payer and provider legal teams.
Must have a keen understanding of competitive factors in the marketplace and current demands that can affect negotiation outcomes with providers.
Some travel is required in and around the state, and to appropriate industry conferences.
Reside in or around Baton Rouge, La
Preferred Qualifications:
Master's Degree in Health Care Administration, Business Administration or a related field.
Doctor of Medicine (M.D.), unrestricted license to practice medicine in a State or Territory of the United States, Board Certified in an ABMS or AOBMS specialty.
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance