Director, Population Health Mgmt

Pay Range

$127,600.00 - $212,500.00

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 build capabilities that support the Company’s objectives to improve health outcomes, member support, and total cost of care. Lead the execution and operationalization of key strategic objectives and play an integral role in driving success of both targeted rapid cycle trend management opportunities as well as comprehensive initiatives aligned with the Company’s population health management priorities.

What You'll Do

• Lead initiatives that support the Company’s population health management strategy including hypothesis development, research, insight generation, and formulation of business recommendations
• Develop targeted population health capabilities from concept to deployment. Evaluate potential solutions including care management, utilization management, vendor relationships and/or other clinical strategies to improve member care
• Utilize data and analytics to evaluate programmatic, operational, and economic tradeoffs and develop recommendations
• Drive portfolio of projects to ensure effective and efficient achievement of the Company’s population health management goals
• Effectively partner with internal stakeholders (Commercial & Medicare business segments, analytics & IT, clinical, legal), external stakeholders (health system, ACO, community partner), and other parties as applicable to support successful program development and deployment
• Work with external vendor partners to develop new capabilities and/or build existing relationships to further business priorities
• Perform other duties as assigned
  
  

What You Need To Succeed

• A combination of education and related work experience
• Seven to ten years’ experience in healthcare program development, consulting, process improvement, operations management, and strategy
• Five to seven years’ management experience or experience leading a team
• Relevant healthcare experience required, preferably health plan or healthcare provider focused with demonstrated understanding of value-based care and population health programs
• Knowledge of managed benefits strategies, utilization review techniques, healthcare financing & delivery, health plan operations and healthcare infrastructure design
• Ability to collaborate while dealing with complex situations
• Ability to think creatively and drive innovation and to leverage both creative problem solving and practical operational perspective
• Strong leadership skills and ability to motivate, lead by influence, and guide a diverse group of stakeholders to a common goal or solution
• Ability to convert business strategy into action-oriented deliverables and measurable results
• Strong business acumen and political savvy
  
  

The Extras

• Masters in relevant field (MBA, MHA, MPA)
• Knowledge of population health management fundamentals, CMS Medicare Advantage programs, healthcare finance and reimbursement methodologies, healthcare quality improvement strategies

Location:

Role

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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