Blue Cross and Blue Shield of North Carolin

Compensation

Full Description

Job Description The Vice President, Medical Economics is a strategic leader responsible for driving medical cost management and healthcare value initiatives across the organization. This role oversees three critical areas: Cost of Care Analytics, Healthcare Value Strategy, and Healthcare Value Operations. The VP will partner with executive and health plan leadership, clinical operations and innovations, and segment finance teams to ensure sustainable cost containment and improved healthcare outcomes. Key Responsibilities Medical Expense Analytics The VP will partner with executive and health plan leadership, clinical operations and innovations, and segment finance teams to ensure sustainable cost containment and improved healthcare outcomes. Key Responsibilities Medical Expense Analytics - Lead analytics to support Health Plan clinical operations and care management programs. - Oversee provider and value-based contracting analytics, including performance measurement and incentive modeling. - Direct pharmacy economics analysis to optimize drug spend and formulary strategies. - Oversee evaluation of program ROI for Cost of Care initiatives and recommend enhancements. - Lead medical expense cost and trend target setting for health plan business segments to drive action and accountability to meet health plan financial goals. - Maintain oversight of medical expense benchmarking and analytical tools to ensure accurate forecasting and reporting. Healthcare Value Strategy - Develop enterprise-wide strategies to reduce medical costs and achieve health plan financial targets. - Collaborate with cross-functional teams to identify opportunities for cost savings and value creation. - Build business cases for new initiatives, including financial modeling and impact analysis. - Facilitate ideation sessions and prioritize initiatives based on ROI, feasibility, and alignment with organizational goals. Healthcare Value Operations - Oversee prioritization of proposed medical cost initiatives. - Ensure timely implementation and monitoring of programs designed to improve healthcare value. - Establish governance processes for initiative tracking, reporting, and performance evaluation. - Partner with clinical, network, and finance leaders to ensure alignment and accountability. Qualifications - Master's Degree in Health Economics, Finance, Business Administration, Public Health, or related field or Fellow of the Society of Actuaries (FSA) • 10+ years of experience in healthcare economics, medical cost management, or health plan analytics. • Proven leadership experience managing large teams and complex initiatives. - Strong knowledge of health plan operations, provider contracting, pharmacy economics, and value-based care models. • Exceptional analytical, strategic thinking, and communication skills. Core Competencies - Strategic Leadership • Financial Acumen - Healthcare Industry Expertise • Data-Driven Decision Making • Collaboration and Influence