Job Abstract

Workplace

Hybrid

Employment Type

Full Time

ID

2024-2945

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.”

The Senior Director, Strategic Provider Partnerships reports directly to the Vice President Provider Partnerships and is responsible for leading key top-tier healthcare partnerships at Capital. This includes managing existing engagements to increase business value as well as seeking new opportunities to expand our partnerships.

The Senior Director’s primary responsibility is designing, implementing, and executing strategies to control the company’s unit costs of care and utilization, which requires extensive knowledge and experience in all aspects of provider reimbursement and provider relationships. Success in this role will be measured by delivering on the agreed-upon goals and metrics of the partnership, driving both short-term and long-term objectives - strategic and financial. The position will work closely with other internal stakeholders - including Capital’s Healthcare Delivery teams, sales, product/services, corporate strategy, marketing team, as well as Capital’s senior management to ensure success of the partnership(s). It requires the capability to work in agile, cross-functional teams and use analytical abilities to come up with creative solutions to business problems, presenting impactful solutions with tangible next steps to executive leadership. This can include:

• Lead healthcare development activities including identification, due diligence, negotiation and consolidation of various types of deals.

• Assists with special projects as assigned by the VP, Provider Partnerships and the SVP, Healthcare Delivery.

Healthcare Strategic Innovation and Partnerships

• In alignment with the overall provider network strategy, establish specific contracting and relationship strategies and tactics for assigned health system providers.
• Proactively manage assigned strategic partnership(s) to deliver on business targets.
• Build & drive strategic plans including program plans, issues, risks, deliverables, achievements.
• Orchestrate the execution of all elements of the partnership agreement, including responsibility for program quality and embedding quality processes into the program.
• Ensure that effective internal processes and legal frameworks are in place to manage and govern the partnership(s)
• Responsible and accountable for managing relationship risk and meeting compliance requirements; identify issues and risks; initiate corrective actions and mitigation strategies as appropriate.
• Ensure that our strategic partnerships and partnership processes are appropriately visible both internally and externally.

• Develop, recommend and implement cross-functional plans and activities to achieve strategic initiatives; communicate insights, progress of challenges and presents resolution scenarios.
• Track and report status on strategic partnerships, risk adjustment, tailored network development and other activities to leadership teams.

• Represent Capital as an industry leader with partners, customers, and other audiences.
• Lead the implementation and management of strategic partnerships, transactions, initiatives, and pilots in a matrix environment post-contract execution/closely working with C-suite level executives.
• Partner with strategic health system business partners to co-develop joint goals and pilot new capabilities and technologies that focus on transformation efforts.
• Comfortable escalating complex issues with recommendations to leadership.
• Strong organizational skills and ability to multi-task in support of multiple projects at a time.

QUALIFICATIONS (Education, Experience, and Certifications)

• Bachelor’s degree in Business Administration, Healthcare Administration, Public Health Administration, or equivalent fields of study or equivalent experience. Master’s in Business Administration preferred.
• 10+ years of experience working in managed care for either a health plan or delegated provider organization or Managed Service Organization
• Minimum five years of successful management experience in either a health plan or large health system
• Minimum of seven years negotiating provider agreements.
• Extensive experience developing, negotiating, and managing risk based (ACO, MLR, Partial and Global Risk) agreements required.
• Demonstrated ability to manage partner programs, and drive execution to deliver results.
• Able to create vision and strategy for the organization through leveraging and connecting strategic relationships and partnerships.
• Ability to think creatively, work on complex problems and provide out-of-the-box solutions.
• Experience with successfully negotiating and restructuring complex agreements.
• Strong attention to detail, entrepreneurial, creative, open-minded, persistent, and collaborative. Prior experience in a strategic customer facing role a plus.
• Strong interpersonal and communication skills.

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.