What We Need

The Medicare Advantage Network Performance Manager, as a member of a cross-functional team, is responsible for engaging and collaborating with provider organizations to effectively manage our value-based Medicare Advantage contracts, advance our mutual goals of delivering high quality and affordable care for our members, and promote profitable membership growth. Performance and growth of our Medicare Advantage line of business is a key priority for our organization and as such, this role is an essential part of moving our strategy forward.

As part of this cross-functional team you will collaborate with our provider network across several domains, including population health management, quality measurement and performance improvement, risk adjustment and coding, and product management and marketing. To accomplish this work, the Medicare Advantage Network Performance Manager will work closely with Provider Informatics, Network Contracting and Management, Performance Measurement and Improvement, Health and Medical Management, and Medicare Markets.

This role is eligible for our Flex persona.

Your Day to Day

• Prepare Medicare Advantage PowerPoint slides for performance meetings with provider organizations.
• Collaborate with Provider Informatics to develop and analyze reports that are used to: monitor provider organizations' membership, Stars performance, and cost and utilization metrics; evaluate drivers of provider performance under Medicare Advantage value-based contracts; and identify, quantify, and monitor provider performance improvement opportunities.
• Lead the development and management of operational models for collaborating with providers around care management, Stars, coding, marketing, etc. The candidate will liaison with BCBSMA operational teams and providers to troubleshoot issues, reduce duplication, and design solutions to ensure the effective management our value-based Medicare Advantage contracts.
• Coordinate with Network Performance Support Team to ensure alignment across products.
• Develop materials and collaborate with provider organizations on strategies to support Stars performance.
• Develop and manage tracking mechanisms to keep senior management informed of the performance of the Medicare Advantage network.
• Conduct ad hoc analyses of membership, provider, and performance data to inform our Medicare Advantage network strategy and contract negotiations.
• Conduct competitive intelligence research to inform the strategic direction of the Medicare Advantage Network Performance work.

*This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.

Qualifications (Knowledge, Skills and Abilities):

• Highly collaborative; ability to act as a team-player; strong relationship management skills (both internally and externally with providers)
• Exceptional analytic skills, including advanced experience with Microsoft Excel
• Solid understanding of healthcare informatics, including cost and utilization metrics across medical/pharmacy service categories, benchmarking methodologies, retention/leakage analytics, and Medicare risk adjustment
• Solid understanding of risk-based contracting models
• Strong communication skills (verbal, written and presentation, including development of frameworks and effective and professional Microsoft PowerPoint materials)
• Strong project management, planning, and organizational skills
• Self-starter able to work independently, manage ambiguity and prioritize effectively.

Education/Relevant Experience:

• BS/BA or equivalent work experience required; Masters preferred
• 5 years of experience in health care finance or population health management, with demonstrated experience in managing risk-based contracts

It is our mission at Blue Cross Blue Shield of Massachusetts to foster a culture that enables associates to do their best work while living happy and healthy lives. That's why we offer you a variety of ways to support your best physical, emotional, financial, and social well-being. For more information on our benefit offerings, visit

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High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theandcan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

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