Affordability Program Manager - Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers 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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

PURPOSE OF THE JOB

• Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.
• Manage Segment Affordability by partnering with Analytics to identify, analyze, interpret, and validate trends, advising Growth and Segment leadership team of affordability challenges and potential mitigating actions.
• Partner with other Cost of Care Workstreams to identify and implement Affordability Initiatives (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)

QUALIFICATIONS

REQUIRED QUALIFICATIONS

• 5 years of experience in analytical, actuarial or business analysis role
• 5 years of experience working for a healthcare organization / health insurer

• Bachelor’s Degree in general field of study

• N/A

• N/A

PREFERRED QUALIFICATIONS

• 5 years of experience in analytical, actuarial or business analysis leadership role
• 7 years of experience working for a healthcare organization / health insurer

• Bachelor’s Degree in Business, Healthcare, Mathematics, Economics, Finance or related field of study.

• N/A

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

PRODUCT AFFORDABILITY (COST OF CARE MANAGEMENT)

• Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.
• Partner with Workstream leadership to identify and implement Affordability Initiatives impacting the Segment (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)
• Partner with Analytics to identify, analyze, interpret, and validate trends and patterns in Segment utilization across provider panels, care settings and other categories, advising segment leadership team of affordability challenges and potential mitigating actions.
• Develop business cases related to Segment cost of care initiatives to support Leadership decision-making and prioritization of opportunities based on balancing organizational alignment, ROI and resource constraints.
• Provide leadership and segment representation on corporate committees, advocating for customer needs and effectively communicating decisions and actions to segment leadership.
• Monitor external economic and healthcare issues affecting cost and utilization trends impacting the industry, the organization, and the segment.

SEGMENT NET