Cost Containment and MLR Optimization Program Lead

SummaryWe are currently hiring for a Cost Containment and MLR Optimization Program Lead to join BlueCross BlueShield of South Carolina. In this role as a Cost Containment and MLR Optimization Program Lead, you will be responsible for the development and management of various health management programs to include Case Management, Disease Management, Utilization Management, Behavioral Health, and Healthcare Development, you will assess impact of programs which may include: performs cost-benefit/feasibility analyses, performs market research assessing corporate competitiveness, and provide strategic direction for reporting, including design, analysis, and validation of outcomes and ROI.

Description

Location

This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be remote. Our ideal candidate must reside within reasonable proximity to Columbia, SC as they will be required to report onsite occasionally for trainings, meetings, or other business needs.

What You’ll Do:

• Develops, implements, evaluates, and maintains health management programs. Positions BCBSSC to compete effectively with other companies. Achieves positive return on investment through oversight of new product/technology development and promotion of service enhancement strategies to increase customer retention.
• Develops and conducts health management presentations to management, internal and external customers that are informative and customized to meet health plan and customer needs.
• Establishes reporting mechanism that details clinical outcomes, utilization statistics and ROI. Develops and maintains specific reporting to include tracking of efficacy, clinical/financial outcomes, research analysis, and the accuracy/timeliness of data collection.
• Provides leadership and direction to staff through employee development, management training, and budget oversight.
• Develops, implements, complies with and promotes staff adherence to corporate and department policies, procedures, and performance and communication standards. Complies with and monitors adherence to URAC case management standards, SC Department of Insurance regulations, SC Nurse Practice Act, all applicable state and federal laws and standards of national accreditation agencies, as management deems necessary.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelors in a job-related field.
• Degree Equivalency: Graduate of Accredited School of Nursing. (Equivalency not applicable for the Celerian Group. Bachelor's degree required.)
• Required Work Experience: 5 years’ clinical or experience developing, implementing and evaluating population health programs with two of the five years in a supervisory role or equivalent military experience in grade E4 or above.
• Required Skills and Abilities: Ability to understand and communicate healthcare policy.
• Working knowledge of word processing, spreadsheet, and presentation software.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Demonstrated customer service, organizational, research, and presentation skills.
• Demonstrated verbal and written communication skills.
• Analytical, critical thinking, and math skills necessary to collect, analyze, and report data.
• Highly developed knowledge of planning, programming, and budgeting activities.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to direct, motivate, and assess performance of others.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: If RN, active, unrestricted RN licensure from United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR if Social Worker or Counselor, active unrestricted licensure as Social Worker or Counselor from the United States and in the state of hire (for Div. 75 only).

We Prefer That You Have the Following:

• Preferred Work Experience: Prior knowledge/experience with Medicare Advantage.
• Preferred Skills and Abilities: Must be proficient in software systems including SAS, Tableau, and Microsoft Excel.
• Must have excellent communication skills as the candidate will be working directly with vendors and internal teams.
• Must have a high degree of technical and analytical skills.
• Must have keen attention to detail and exceptional time management skills

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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Originally posted on Himalayas