Blue Cross and Blue Shield of North Carolina

Compensation

Full Description

Job Description Leads and oversees the design of population health strategy initiatives and programs to improve care coordination and health outcomes including developing efficiencies in programs (clinical and non-clinical). Works alongside senior leadership to monitor the effectiveness of care and identifying areas for process improvement to manage costs and to comply with federal and state regulations. Collaborates closely with project team members, business owners and sponsors to develop, implement and monitor initiatives that can improve member health outcomes, reduce provider administrative burden, and/or reduce medical or operational expense through a variety levers, including clinical workflow innovation, operational efficiency, prior authorization management, and AI-enabled care. What You'll Do • Gathers input from across the enterprise, division, community, members and through competitive intelligence to identify opportunities, assess needs and develop strategic design of solutions. Ensures alignment of solutions across the enterprise. • Develops business cases, strategy concept designs and program requirements.Serves as a subject matter expert, routinely briefing leaders and key stakeholders on program goals and initiatives. • Develops project plans and recommendations in support of compliance objectives and leads implementation. Tracks and reports on the status of projects. Assesses project risks, develops mitigation and contingency plans. • Identifies analyzes and understands target audiences and their specific program needs. Develops and deploys marketing strategy to increase member engagement in maternal health programs. • Leads vendor identification, evaluation, selection and contract negotiations for new vendor relationships. • Works with senior leadership team to support clinical initiatives and/or programs are in accordance with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements • May work across multiple Line of Business and states to encompass program needs into population health strategies • Establishes and monitors performance metrics and goals for assigned programs, including process measures, outcomes measures, financial measures and methodologies for implementing programs. Documents and presents program results through operational reports, outcomes studies and presentations. • Owns and makes needed decisions to ensure the successful resolution of issues within the program to achieve milestones and program deliverables. • Incorporates evaluation planning into the overall strategy. Establishes key performance indicators for programs, including process measures, outcomes measures and financial measures. Ensure program is designed in such a way that these metrics can be collected and monitored. What You'll Bring • Bachelor's degree or advanced degree (where required) • 5+ years of experience in related field (strategic planning and program management for health plan) • In lieu of degree, 7+ years of experience in related field Bonus Points • Clinical background preferred What You'll Get • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community • Work-life balance, flexibility, and the autonomy to do great work • Medical, dental, and vision coverage along with numerous health and wellness programs • Parental leave and support plus adoption and surrogacy assistance • Career development programs and tuition reimbursement for continued education • 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. • Based on annual corporate goal achievement and individual performance. $89,174.00 - $142,679.00 Skills Business Process Improvements, Implementation Management, Process Improvement Initiatives, Process Improvements, Project Management, Project Management Oversight, Project Performance Management (PM), Project Plan Development, Resource Management, Resource Planning Job Description Leads and oversees the design of population health strategy initiatives and programs to improve care coordination and health outcomes including developing efficiencies in programs (clinical and non-clinical). Works alongside senior leadership to monitor the effectiveness of care and identifying areas for process improvement to manage costs and to comply with federal and state regulations. Collaborates closely with project team members, business owners and sponsors to develop, implement and monitor initiatives that can improve member health outcomes, reduce provider administrative burden, and/or reduce medical or operational expense through a variety levers, including clinical workflow innovation, operational efficiency, prior authorization management, and AI-enabled care. What You'll Do • Gathers input from across the enterprise, division, community, members and through competitive intelligence to identify opportunities, assess needs and develop strategic design of solutions. Ensures alignment of solutions across the enterprise. • Develops business cases, strategy concept designs and program requirements.Serves as a subject matter expert, routinely briefing leaders and key stakeholders on program goals and initiatives. • Develops project plans and recommendations in support of compliance objectives and leads implementation. Tracks and reports on the status of projects. Assesses project risks, develops mitigation and contingency plans. • Identifies analyzes and understands target audiences and their specific program needs. Develops and deploys marketing strategy to increase member engagement in maternal health programs. • Leads vendor identification, evaluation, selection and contract negotiations for new vendor relationships. • Works with senior leadership team to support clinical initiatives and/or programs are in accordance with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements • May work across multiple Line of Business and states to encompass program needs into population health strategies • Establishes and monitors performance metrics and goals for assigned programs, including process measures, outcomes measures, financial measures and methodologies for implementing programs. Documents and presents program results through operational reports, outcomes studies and presentations. • Owns and makes needed decisions to ensure the successful resolution of issues within the program to achieve milestones and program deliverables. • Incorporates evaluation planning into the overall strategy. Establishes key performance indicators for programs, including process measures, outcomes measures and financial measures. Ensure program is designed in such a way that these metrics can be collected and monitored. What You'll Bring • Bachelor's degree or advanced degree (where required) • 5+ years of experience in related field (strategic planning and program management for health plan) • In lieu of degree, 7+ years of experience in related field Bonus Points • Clinical background preferred What You'll Get • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community • Work-life balance, flexibility, and the autonomy to do great work • Medical, dental, and vision coverage along with numerous health and wellness programs • Parental leave and support plus adoption and surrogacy assistance • Career development programs and tuition reimbursement for continued education • 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. • Based on annual corporate goal achievement and individual performance. $89,174.00 - $142,679.00 Skills Business Process Improvements, Implementation Management, Process Improvement Initiatives, Process Improvements, Project Management, Project Management Oversight, Project Performance Management (PM), Project Plan Development, Resource Management, Resource Planning