Senior Director, Payment Innovation
Company: Blue Shield of California
Posted on: June 9, 2021
Reporting to the VP, Health Transformation Lab, the Senior
Director, Payment leads the design and development of innovative
alternative payment models, incentives and reimbursement programs,
practice recruitment, implementation, scaling, measurement and
integration with other BSC clinical and network initiatives
designed to incentivize providers to shift to pay for value. The
Senior Director will also develop payment approaches to cover the
cost of solutions to address social determinants of health and to
drive health equity, partnering with other product developers and
peers to co-design products and services that enable providers to
optimize their use of pay for value payment models and other
payment approaches while ensuring improvements in members' health
outcomes and health equity. The Senior Director manages a team,
works directly with pilot leaders and targeted practices, and
partners with other parts of BSC to accomplish these goals.
- Develop a strategy to lead the industry in development and
adoption of innovative payment models and approaches.
- Develop payment models, payment approaches and other exchanges
of value as products/services that drive the shift from fee for
services to pay for value.
- Co-design products/services that encompass payment models and
approaches and other innovative products/services that maximize or
optimize the value afforded to providers and their patients.
- Develop and implement new and innovative payment models across
multiple specialty areas to promote better health and
- Work with providers to test and implement innovative payment
models that support new clinical models.
- Identify and design scaling strategies to offer new models of
care and payment statewide.
- Execute the roadmap strategy for development and implementation
of bundled payment capability within Blue Shield and other bundled
models that can support advancing the specialty care practices of
- Lead work to select new specialty care areas using an evidence
process, and in collaboration with other HTNA business teams. Plan
for implementation of new specialty care areas in 2021 and beyond
as identified within the strategic portfolio for HTNA.
- Partner with internal and external communications departments
to tell the story of how these programs benefit BSC members.
- Work across BSC to make needed operational, contractual and
policy changes needed to deploy and scale new payment models.
- Develop multi payer partnerships including public payers that
enable aligned payment transformation.
- Foster a culture of innovation, creativity and disciplined
product design and development to enable Blue Shield to meet its
Knowledge and Experience
- Bachelor's degree is required; advanced degree (MBA, MHA, MPA,
MS in mathematics or statistics or equivalent) preferred.
- 5+ years clinical program development, and quality improvement
- 5 years of experience designing payments, monetization
strategies, financial instruments and/or products in financial
services, fintech or insurtech
- 3+ years working in a health plan or health system.
- Technical knowledge of payment model design and experience
implementing new payment models with physicians.
- 6-10 years of progressive people leadership experience in a
- Technical knowledge of financial and risk modeling to support
- Clinical training and experience preferred.
- Working operational knowledge of the key synergies necessary
among pracitecs, payers, community and policy leaders.
- About Company: At Blue Shield of California we are parents,
leader, students, visionaries, heroes, and providers. Everyday we
come together striving to fulfill our mission, to ensure all
Californians have access to high-quality health care at a
sustainably affordable price. For more than 80 years, Blue Shield
of California has been dedicated to transforming health care by
making it more accessible, cost-effective, and customer-centric. We
are a not-for-profit, independent member of the Blue Cross Blue
Shield Association with 6,800 employees, more than $20 billion in
annual revenue and 4.3 million members. The company has contributed
more than $500 million to Blue Shield of California Foundation
since 2002 to have a positive impact on California communities.
Blue Shield of California is headquartered in Oakland, California
with 18 additional locations including Sacramento, Los Angeles, and
San Diego. We're excited to share Blue Shield of California has
received awards and recognition for - LGBT diversity, quality
improvement, most influential women in corporate America, Bay
Area's top companies in volunteering & giving, and one of the
world's most ethical companies. Here at Blue Shield of California,
we're striving to make a positive change across our industry and
the communities we live in - Join us!
- Physical Requirements:
Office Environment - roles involving part to full time schedule
in Office Environment. Based in our physical offices and work from
home office/deskwork - Activity level: Sedentary, frequency most of
Please click here for further physical requirement detail.
- EEO Footer: External hires must pass a background check/drug
screen. Qualified applicants with arrest records and/or conviction
records will be considered for employment in a manner consistent
with Federal, State and local laws, including but not limited to
the San Francisco Fair Chance Ordinance. All qualified applicants
will receive consideration for employment without regards to race,
color, religion, sex, national origin, sexual orientation, gender
identity, protected veteran status or disability status and any
other classification protected by Federal, State and local
- Requisition ID: 21001FQ
- Posting Date: May 27, 2021
- Schedule: Full-time
Keywords: Blue Shield of California, Oakland , Senior Director, Payment Innovation, Other , Oakland, California
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