Director, Program and Project Management (Payment Innovation)

Your Role 

The Payment Innovation team leads the strategy, design, development, and implementation of value-based payment models. The Director, Program and Project Management  - Payment Innovation will report to the Senior Director of Payment Innovation. In this role you will be responsible for leading the strategy and end-to-end design of multiple new value-based payment models, leading the end-to-end program of multiple new and current payment models and the outcomes of those 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: 

• Oversee and lead the design and implement value-based payment models/payment mechanisms spanning across business areas where analysis requires evaluation of intangible variance factors. 
• Lead contract writing, revisions, and tracking for value-based payment models 
• Be the subject matter expert on Value Based payment, ACOs,  OCHA value Based payment requirements, Learning and Action Network (LAN) Value Based Care criteria, CMMI models, and CMS strategies.   
• Engage with all levels including senior management, make recommendations, and influence decision-making on alternative and value based payment model 
• Lead and leverage cross-functional internal and external relationships to drive initiatives forward 
• Lead a team to plan and implement complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Lead the development of pay for value strategies and new products 
• Lead cross functional project teams, including defining meeting agenda, lead meetings, capture meeting notes, and follow-up on action items

Your Knowledge and Experience 

• Requires a bachelor’s degree or equivalent experience

• Requires at least 10 years prior relevant experience, including 6 years of management experience

• Previous experience in value-based care design including designing value-based payment models or financial models is preferred

• Requires previous experience in designing a program/initiative end-to-end, including conceptual design, implementation planning and execution, and on-going operational support

• Requires contract writing experience or experience in drafting documents 

• Required knowledge and experience of health insurance business and structure, preferably within a payor

• Requires experience with aligning disparate stakeholders and driving towards outcomes 

• Requires 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 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. 

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.

Please click here for further physical requirement detail. 

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.