Job Description

Your Role

The Payment Innovation team leads the design, development, and implementation of value-based payment models. The Program Manager, Consultant - Payment Innovation will report to the Senior Manager of Payment Innovation. In this role you will be responsible for leading the end-to-end design of new value-based payment models, leading the end-to-end program of payment models current payment models that support Blue Shield’s strategic goals. He/she/they will manage program(s) from initiation through delivery, perform operational responsibilities, and monitor for continuous improvement.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Support the design and implement value-based payment models/payment mechanisms spanning across business areas where analysis requires evaluation of intangible variance factors.
• Support contract writing, revisions, and tracking for value-based payment models
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward
• Plan and implement complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Conducts market research and literature review on alternative payment models and clinical redesign efforts
• Manage project/program planning to ensure completion of key deliverables and reporting
• Lead cross functional project teams, including defining meeting agenda, lead meetings, capturing meeting notes and follow-up on action items

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Contract writing experience or experience in drafting documents strongly preferred
• Previous experience in value-based care design including designing value-based payment models or financial models preferred
• Previous experience in designing a program/initiative end-to-end, including conceptual design, implementation planning and execution, and on-going operational support strongly desired
• Knowledge and experience of health insurance business and structure, preferably within a payor preferred
• Desired qualification of experience with aligning disparate stakeholders
Experience with payor data infrastructure, regulations for various lines of business and contracting preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.

• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

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.

Equal Employment Opportunity:

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.

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