Job SummaryUnder the direction of the Director Care Management Programs, the Manager Disease Management and Wellness Programs is responsible for the design, implementation, and oversight of Disease Management and Wellness programs that promote member health, improve quality of life, and reduce healthcare costs for all lines of business. The role ensures programs meet the needs of members, providers, employer groups, and national accounts such as the Federal Employee Program (FEP). The Manager oversees a variety of health interventions including digital tools, outreach campaigns, telephonic support, and community-based initiatives. The role manages daily operations, program evaluation, and quality improvement activities, including URAC accreditation, and HEDIS measures.
"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."
What you'll do- Manage staff and team operations, including hiring, performance management, policy enforcement, disciplinary action, termination processes, compliance, team development, and maintaining accurate documentation.
- Lead the design, implementation, and evaluation of disease management, wellness, preventive care, and chronic condition programs aligned with corporate goals and quality/accreditation standards (e.g., HEDIS, URAC, STARS).
- Analyze health risk, claims, and program data to guide population health strategies, prioritize initiatives, and inform program development and continuous improvement.
- Develop, validate, and monitor performance metrics, outcomes, and ROI; prepare and present reports to internal committees and external stakeholders (e.g., employer groups, national accounts such as FEP).
- Oversee department data systems and platforms, including vendor-supported tools, reporting capabilities, and IT project prioritization.
- Manage vendor relationships and contracts, including pricing, compliance, and performance guarantees; support accreditation readiness and re-accreditation activities.
- Coach, develop, and train a multidisciplinary team to execute program operations effectively, including outreach and engagement strategies.
- Escalate and resolve operational and interpersonal issues within the staff hierarchy and between clinical and non-clinical staff.
- Collaborate with providers, employer groups, community-based organizations, and internal teams; support RFP/RFI processes and represent the organization on external committees as assigned.
- Create and manage annual departmental plans and budgets (~$2M); ensure compliance with applicable laws/regulations, internal policies, HIPAA, safety standards, and information security requirements.
What you needKnowledge/Skills/Abilities- Knowledge of applicable state and federal guidelines and requirements impacting health programs, including Kansas Insurance Department incentive guidelines and Federal Employee Program (FEP) operational guidelines.
- Understanding of member and provider contracts across lines of business and how contractual requirements translate into program operations.
- Knowledge of healthcare accreditation and regulatory frameworks (e.g., NCQA, URAC) and ability to interpret standards to support compliance and quality improvement.
- Knowledge of outcomes measurement methodologies, performance metrics, and quality reporting.
- Strong analytical and problem-solving skills, including the ability to interpret healthcare and program data to drive decisions.
- Excellent interpersonal skills and ability to build and maintain relationships with internal partners, external vendors, providers, employer group leaders, and members.
- Advanced written and verbal communication skills, including the ability to present complex information clearly to diverse audiences.
- Ability to manage complex projects and competing priorities with attention to detail, adaptability to change, and a focus on results.
Education and Experience- Bachelor's Degree in Nursing, Healthcare Administration, Health Services Management, Public Health, or a related field required.
- Current, active, and unrestricted licensure as a Registered Nurse in the state of Kansas required.
- Minimum of 7 years of broad clinical experience in healthcare settings and at least 5 years of experience in the health insurance industry required.
- 5 or more years in a management or leadership role required
- Certification as a Case Manager (CCM) and/or Certified Diabetes Care and Education Specialist (CDCES), additional certification in healthcare quality, and demonstrated experience applying statistical methods to quality management or healthcare research preferred.
Physical Requirements- Ability to sit for extended periods while working at a computer, with intermittent standing and walking throughout the workday.
- Ability to communicate effectively in person and via phone/video conference, including participating in meetings for extended periods.
- Ability to occasionally lift, carry, push, or pull up to 25 pounds (e.g., files, materials, or equipment) as needed.
Compensation$118,320 - $140,500 annually
Exempt Grade 18
- Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
