Pay Range:
$116,900.00 - $187,100.00
Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Why this job matters:
Identify and lead new capabilities and initiatives to improve health outcomes, member support, and total cost of care for low-income Medicare membership. Oversee program execution; collaborate with internal and external business areas to identify and develop models that improve the member experience, improve member health outcomes, and reduce healthcare costs. Serve as the point of accountability for low-income population health management initiatives and performance.
What you will do:
- Develop a deep understanding of the needs of low-income Medicare population; the social, behavioral, and medical risk factors that affect cost of care; and the ecosystem of Medicare and Medicaid providers, community-based organizations, government agencies, and private entities that influence members’ healthcare experiences and outcomes.
- Design data-informed solutions that support reduced medical expense for targeted low-income cohorts, including members with serious and persistent mental illness.
- Assess vendor-partner and internally developed options that can improve medical expenses and the member experience.
- Strengthen key external relationships, introduce shared initiatives, and track outcomes, including data-sharing opportunities with Certified Community Behavioral Health Clinics to improve support for members with behavioral health conditions.
- Develop targeted population health capabilities from concept through deployment, evaluating solutions such as care management, utilization management, vendor relationships, and other clinical strategies to improve member care.
- Work closely with the D-SNP clinical team to incorporate frontline insights and support operational execution.
- Use data and analytics to evaluate programmatic, operational, and economic tradeoffs and develop recommendations.
- Partner effectively with internal stakeholders, including Population Health, Analytics and IT, Clinical, Network, and Quality; external stakeholders, including health systems, ACOs, and community partners; and other parties as appropriate to support successful program development and deployment. Perform other duties as assigned.
What you need to succeed:
- A combination of education and related work experience.
- Seven to ten years of experience in healthcare program development, consulting, process improvement, operations management, and strategy.
- Relevant healthcare experience required, preferably in a health plan or healthcare provider environment, with experience serving Medicaid or dual-eligible populations.
- Knowledge of managed-benefit strategies, utilization-review techniques, healthcare financing and delivery, health plan operations, and healthcare infrastructure design.
- Knowledge of managed-benefit strategies, utilization-review techniques, healthcare financing and delivery, health plan operations, and healthcare infrastructure design.
- Ability to collaborate effectively while navigating complex situations.
- Ability to think creatively, drive innovation, and combine creative problem-solving with a practical operational perspective.
- Ability to motivate, lead through influence, and guide diverse stakeholders toward a common goal or solution.
- Ability to translate business strategy into action-oriented deliverables and measurable results.
- Strong business acumen and political savvy.
The extras:
- Master’s degree in a relevant field, such as an MBA, MHA, or MPA.
- Knowledge of population health management fundamentals, CMS Medicare Advantage programs, healthcare finance and reimbursement methodologies, and healthcare quality-improvement strategies.
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
