The posting
Pay Range:
$116,900.00 - $187,100.00
Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.
We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.
Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.
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
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.
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