Director BlueCard Executive & Mandates Details

Director BlueCard Executive & Mandates

Blue Cross Blue Shield of Arizona - Phoenix, AZ

Employment Type : Full-Time

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

The Director BlueCard Executive & Mandates will serve as the liaison for the Blue Cross Blue Shield of Arizona (BCBSAZ) Plan with the Blue Cross Blue Shield Association (BCBSA). This role is accountable for all InterPlan and BCBSA governance and policy matters which require strong collaboration with internal and external stakeholders to ensure that all BCBSA initiatives are represented, responded to, and resolved. In addition, this role is responsible for the implementation and compliance, while evaluating business implications with related regulatory requirements (i.e. No Surprises Act and Consolidated Appropriations Act). This position will report directly to the Chief Service Officer.

REQUIRED QUALIFICATIONS

Required Work Experience

• 5 years of management experience
• 5 years of experience in health care, data and systems management
• 3 years of compliance, internal audit or regulatory experience

Required Education

• BA / BS in Business Administration, Health Policy Administration or related field

Required Licenses

• N/A

Required Certifications

• N/A

• 7 years of experience working in a health care, professional environment, with the ability to interface with internal and external stakeholders at various levels, including executive leadership.
• 5 years of experience in data and information analysis and system management
• 5 years of experience in project management, sales, marketing or product management
• 5 years of experience in developing short and long range strategic plans, forecasting, and budgeting
• 5 years of experience Corporate Compliance

• Strong interpersonal, communication, documentation and problem solving skills.
• Ability to develop connections and facilitate discussions within the company to represent BCBSAZ externally at industry-related events.
• Strong knowledge of health insurance industry issues, knowledge of National Accounts markets, trends, practices, products, and rate setting.
• Significant and broad knowledge of Blue Cross Blue Shield Plans, BCBSA initiatives and governance.
• Knowledge of National Programs processes, including BlueCard, National Accounts, Medicare Advantage, Member Touchpoint Measurements (MTM), in addition to a strong understanding of the Federal Employee Program (FEP) is a plus.

• BA / BS in Business Administration, Health Policy Administration or related field

• N/A

• PMP Certification

BLUECARD EXECUTIVE RESPONSIBILITIES

• Act as a central point of contact for BCBSA and partner Plans. Ensure initiatives, association strategy, policy making and interdependencies are aligned with the company strategy and business operations.
• Participate in Association workgroups, committees and task forces as required and creates strategic positioning and alliance with like-minded Blue Plans to form coalitions in pursuing policy positions.
• Represents and protects the company’s perspective in both operations and the national market place and oversees appropriate committee representation to support organizational alignment, buy-in and input from stakeholders.
• Collaborates with BCBSAZ business leaders, including Executive Leadership and Segment General Managers, to capture Association needs including the implementation of the MDL settlement.
• Directs responsibility for ongoing Blue policy development, interpretation, enforcement and application analyses.
• Develops strategic direction for InterPlan organization, performs analysis and briefs executive leaders on impacts.
• Determines governance process, training and manages internal communications and information exchange on BCBSA initiatives, issues, planning and performance on a timely basis.
• Provides financial oversight of Home and Host pricing to meet budget and forecast goals.
• Intake, support, monitor and report on BCBSA mandate activities. Partner with appropriate areas to evaluate changes and ensure BCBSAZ is in compliance and certified as required.
• Supports and promotes all BCBSA performance measurements and ensure action plans are in place as needed.
• Represents BCBSAZ at BCBSA and other industry events and participates in speaking engagements, panel discussions, and account presentations.
• Troubleshoots issues with appropriate internal area on behalf of other BCBSA Plans. Coordinates resolution and communicates outcome between Plans.
• Manages Inter-Plan activities for national account implementations for BCBSAZ as a Control and Par Plan.
• Coordinates Plan responses to Inter-Plan Programs surveys and other information requests as required.
• Escalates problems for timely resolution when contacted by BCBSA or another Plan.
• Facilitates internal company meetings to share best practices.
• Communicates with BCBSA and staff of other Plans on issues related to Inter-Plan Programs and expected impacts of proposed Program enhancements.
• Coordinates with appropriate Plan staff any time-sensitive Inter-Plan Programs Technology software implementations and new functions
• Monitors / Coordinates systems implementation and modification activities in conjunction with technical managers and management to support Inter-Plan Programs requirements. (Includes BCBSA and PlanConnexion applications and systems).
• In coordination with the BCBSAZ VB team, monitors BCBSA mandates/ initiatives related to Value Based Program initiatives, operations, financial settlements, membership and attribution.

DIRECTOR MANDATE IMPLEMENTATION & COMPLIANCE (in addition to the above responsibilities)

• Develop, implement, and maintain processes for reviewing information about new laws and regulations and changes in interpretation on laws and regulations obtained from various sources
• Interact with legal department to review and evaluate policies and procedures
• Works collaboratively with Internal Audit to ensure internal controls are in place and that internal monitoring, auditing and oversight functions are being performed, and that deficiencies are corrected
• Consults and coordinates with various internal departments, external Blue Plans or business partners and government agencies where appropriate.
• Tracks, Monitors and reports on progress in achieving actions according to required time lines
  

OVERALL

• Oversee day-to-day departmental activities and adheres to company policies and procedures.
• Position requires travel to the BCBSA office, meeting locations, as well as other BCBS Plans.
• Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize efficiencies.
• Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
• Maintain effective working relationships to ensure teamwork in achieving corporate goals.
• Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.
• Support BCBSAZ’s Core Value of maintaining a heritage of service, by volunteering with, serving on, and supporting multiple Boards of Directors within the community.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

REQUIRED COMPETENCIES

• Strong written and verbal communications.
• Intermediate PC proficiency.
• Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
• Intermediate skill in word processing, spreadsheet and database software.
• Intermediate skill using departmental BCBSAZ software, specifically claims processing and EDI applications.

• Management skills in an operationally changing environment, with drive for results and success based on planned objectives.
• Strong customer service skills.

• Expert knowledge of National Programs Policies & Provisions Licensee requirements.
  • Interpersonal skills that allow for collaborative working relationships with internal and external stakeholders
  • Recognize strategic opportunities and use data to make timely and sound decisions.
  • Flexibility and willingness to adjust to shifting demands/priorities.
  • Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs.

• High standard of performance while pursuing aggressive goals
• Principled leadership and sound business ethics

PREFERRED COMPETENCIES

• N/A

• N/A

• N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank You

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.