VP, Medical Economics

Blue Cross and Blue Shield of North Carolina

7d•Remote

About The Position

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 About Us It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. Authorization to Work in the United States We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español. Request Accommodations Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected]. For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming

Requirements

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.

Responsibilities

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.
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.
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.