JOB DESCRIPTION
Your Role

The Provider Partnerships team is looking for an HMO Data Insights Business Consultant that will help us discover information hidden in vast amounts of data that will lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare . You will report to the Sr Manager of HMO Data Insights. Your focus will be in strategic partnerships with our stakeholders, reporting and business analysis of performance primarily focused on the HMO line of business (ACO, Medicare, Medi-Cal). You will be collaborating with our provider partnership leaders, helping them understand support needs, define / drive strategy and priorities leveraging data and analytics solutions to support strategic and operational objectives.

Your Work

In this role, you will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California strategic goals
• Review IPA and Hospital performance metrics and gather insights and recommendations for our internal and external stakeholders to achieve optimal member cost and utilization outcomes
• Extensive knowledge of CPT, HCPCS, ICD-10s and other related industry codes related to building the DOFR assignment
• Consults with appropriate internal partners on issues and interpretations of the DOFR’s Risk assignment and fully understand the linkages between Benefits, Contracts and Claims
• Consults with appropriate internal partners on issues and interpretations of the DOFR’s Risk assignment and fully understand the linkages between Benefits, Contracts and Claims
• Work cross-functionally with Actuary, MCS, Data & Analytics, Finance, Quality, Revenue Enhancement, Pharmacy and Network Management to enable a 360 review of all facets of a provider’s performance profile
• Collaborate closely with the Regional Medical Directors and clinicians and recommend strategic action for improving cost and use of healthcare
• Develop strong, strategic partnership with internal and external stakeholders
• Utilize and recommend enhancements to existing self-service reporting solutions
• Understands the data structures and sources, and the use of analytical or statistical tools to create meaningful insights that drive strategic action and results

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Able to function independently and produce results that meet standards of quality, timeliness, and acceptability. Receives minimal supervision and general direction
• Known for having a problem-solving style that’s balanced between “analytical” and “intuitive”
• Ability to thrive in ambiguous situations
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, directors, managers, and subject matter experts
• Ability to establish and maintain effective and collaborative relationships with key stakeholders
• Advanced skills using Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management. Proficient at using MS Project
• Technically proficient having broad background in problem solving tools
• Knowledge of Blue Shield of CA or similar health care organization structure
  

Pay Range:

The pay range for this role is: $ 94160.00 to $ 141240.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.