Director Of Risk Adjustment And Quality Analytics

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

We are looking for a Director of Risk Adjustment and Quality Analytics to lead a team that delivers insights and results in support of the Risk Adjustment and Quality programs. This position plays a leadership role in enabling improved accuracy in understanding the illness burden of our membership to better manage their risk, care, and health.

A Day in the Life:

• Performs risk score computation and forecasting for Medicare, ACA, and Medicaid.

• Oversees diagnostic coding gap identification (suspecting), confidence modeling, and benchmarking.

• Responsible for operational metric tracking and performance improvement opportunity identification.

• Involved with the targeting and evaluation of in-home assessment, chart review, and point of care programs.

• Calculates the financial impact of various improvement opportunities and provides guidance for pricing and budget.

• Provides strong leadership to the Quality and Risk Adjustment Analytics team, including building a successful team, developing strategic partnerships, and influencing across Blue Cross highly matrixed organizational structure to represent enterprise risk adjustment and quality interests.

• Stays abreast of changes in the rapidly evolving health care marketplace and understands how trends, competitors, external context, and internal dynamics shape opportunities and challenges for the business.

• Effectively communicates complex concepts, strategies, initiatives, analytics, and results to a variety of stakeholders, including senior staff and executive leadership.

• Understands the strategy and future direction of Blue Cross, as well as challenges and opportunities that are inherent to that strategy and direction.

• Ensure that the priorities of the team reflect the company's strategic direction, and ensure the team's knowledge, skills, and ability are adequate to meet current and evolving needs of the Risk Adjustment and Quality programs.

• Directs the team, including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.

• Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations, and cost control.

Nice to Have:

• Master's degree in health services research or statistics or related area

• Senior leadership experience in a health care company

• Business intelligence experience

Required Skills and Experiences:

• Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.

• 7+ years of related professional experience, with 3+ years of management experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• ASA or above

• Demonstrated ability to evaluate quantitative data from multiple sources using statistical modeling, analytical methods, and critical thinking skills.

• Proficient with methods and tools to perform statistical analysis, performance measurement, and cost analysis.

• Proficient with statistical software suites (e.g. SAS, cloud-based platforms), strong understanding of database structure, relational database concepts and data architecture.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

• Strong problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solutions.

• Superior executive level communication, facilitation, and presentation skills.

• Proven ability to establish trust and build collaborative relationships with key constituents (internal leaders and experts across the organization).

• Ability to navigate ambiguity in a complex, matrixed environment.

• Must be a strategic problem solver, with a high level of intellectual curiosity and openness to change.

• Proven ability to perform complex business analysis and decision-making, with the ability to effectively analyze and synthesize large amounts of complex data in relevant insights.

• Demonstrated experience in collaboration, teamwork, and cross-functional communication.

• Demonstrated ability to communicate across a large, complex health care organizations and deliver persuasive messages based on thorough fact-based analysis.

• Effective, concise, and professional written, verbal and presentation skills.

• Knowledge of healthcare industry including familiarity with health benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches.

• Flexible, self-motivated, and continuously seeking ways to improve.

• Demonstrated leadership ability exemplified by a capacity to think strategically and implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration; and ability to develop and lead high performance and collaborative teams.

Role Designation:

Hybrid Remote

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.