Program Manager, Clinical Ops.
The Blue Cross and Blue Shield Association (BCBSA) is a membership organization of independently owned insurance companies and is the strategic leader behind the Blue Cross and Blue Shield (BCBS) brand, one of the most recognized brands in America and the choice of nearly 100 Million Americans for their healthcare coverage. There are 36 Blue Cross Blue Shield Plans across the country and internationally which depend on BCBSAs consulting and operational support, enabling them to move proactively to gain a competitive edge in their respective markets.
The program manager will be responsible for Identifing, developing, and implement analytical health care financing models to increase the value of services for Plans and internal customers. Manages multiple, complex cross-boundary projects, services and associated deliverables related to data analysis activities in support of FEP objectives, including Plan consulting. Presents opportunities for benefit cost savings and reducing variations in utilization through the development and implementation of benefit cost containment strategies by providing leadership with care coordination implementation and care management initiatives. Consults with individual Blue Cross and Blue Shield Plans, supporting their efforts to establish effective network strategies by defining and establishing regional and national utilization benchmarks. Participates in and may lead larger, more complex projects, functioning as a strategic and technical resource as well as a subject matter expert.
Responsibilities include but are not limited to:
- Oversees or conducts formal market assessments of best practices in the health industry addressing the management and use of healthcare information and determines the business value and practicability for FEP. Conducts analyses, interprets findings, and develops recommendations and/or strategies to meet FEP and BCBSA core objectives. May lead or participate on team to take recommendation to implementation.
- Collects, analyzes, synthesizes and/or maintains complex data utilizing databases, survey instruments, information resources, or other research methodology. Advises and supports Plans on data analysis and reporting to support benefit cost, Care Coordination, and care management initiatives.
- Advises and supports Plans and internal business partners on data analysis and reporting in support of benefit cost and/or care management initiatives. Continues to identify and assess opportunities for process/systems improvement.
- Contributes to and executes projects and deliverables that cross many functional boundaries. Primary liaison to the Plans’ FEP healthcare analyst and multiple functional areas concerning the maintenance of benefit cost models and strategies for FEP.
- Represents department and FEP on internal and external groups, as assigned. Build/maintain excellent relationships with internal and external business partners and/or customers. Serve as a liaison or contact between FEP analytics and key customers. Serves as an ongoing conduit of information from customers to appropriate BCBSA staff.
Required Basic Qualifications:
- Bachelor’s degree in health care or related field or equivalent work experience
- Minimum of three years of experience within a managed care or health services delivery setting, with expertise in claims, provider contracting, benefit cost containment programs and/or healthcare informatics
- Minimum of three years’ experience in consulting on and implementing cost-effective care management programs
Preferred Basic Qualifications:
- Advanced analytic skills with the ability to analyze and interpret data through complex analysis and develop innovative approaches to data analyses
- Good project management skills for planning and executing multiple projects, involving multiple stakeholders, under tight deadlines
- Ability to build consensus for business results in a decentralized decision-making structure, relying on excellent process management and conflict management skills
- Advanced time and resource management skills with the ability to develop approaches that meet required objectives
- Excellent communication (written and oral) and interpersonal skills with an ability to communicate to small and/or large audiences (both internal and external to BCBSA)
- Experience working with large data repositories and/or relational databases, as well as, experience with data mining
- Knowledge of SAS, SPSS, SQL, Cognos, MCSource or other analytical tools or languages
- Demonstrated integrity in decision-making and actions
- Strong PC skills with experience using database programs, spreadsheets, and word processing, including all components of MS Office (particularly MS Excel and MS Access).
- Certification by the Academy for Healthcare Management (AHM) is a plus.
- Advance AHM certifications, certification by the American College of Healthcare Executives or Certified Health Consultant (CHC) certification is a plus.