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Senior Director, Payment Innovation

Company: Blue Shield of California
Location: Oakland
Posted on: June 9, 2021

Job Description:

Job Summary

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 outcomes.
  • 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 the future.
  • 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 strategic goals.

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 experience.
  • 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 healthcare environment.
  • Technical knowledge of financial and risk modeling to support product design.
  • Clinical training and experience preferred.
  • Working operational knowledge of the key synergies necessary among pracitecs, payers, community and policy leaders.

Additional Information

  • 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 work day.

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 laws.
  • 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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