Summary
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose:
The Care Connected Clinical Program Manager is responsible for the development and management of a key concierge care program. In this role, you will assess impact of programs which may include: performing cost-benefit/feasibility analyses, performing market research assessing corporate competitiveness. You will provide strategic direction for reporting, including design, analysis, and validation of outcomes and ROI in a fast-paced, growing environment with shifting priorities.
Logistics:
This position is full-time (40 hours/week, 8 hours/day) Monday - Friday, REMOTE - W@H South Carolina, W@H Georgia, or W@H North Carolina. Periodic travel to Columbia, SC for meetings.
What You'll Do:
- Develop, implement, evaluate, and maintain health management programs.
- Position BlueCross BlueShield of South Carolina to compete effectively with other companies.
- Achieve positive return on investment through oversight of new product/technology development and promotion of service enhancement strategies to increase customer retention.
- Develop and conduct health management presentations to management, internal and external customers that are informative and customized to meet health plan and customer needs.
- Establish reporting mechanism that details clinical outcomes, utilization statistics and ROI.
- Develop and maintain specific reporting to include tracking of efficacy, clinical/financial outcomes, research analysis, and the accuracy/timeliness of data collection.
- Provide leadership and direction to staff through employee development, management training, and budget oversight.
- Develop, implement, comply with and promote staff adherence to corporate and department policies, procedures, and performance and communication standards.
- Comply with and monitor 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:
- Required Education: Bachelor's degree
- 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:
- 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 You to Have:
- Payor plan leadership experience and/or clinical program leadership experience in a payor setting
- 10 years clinical experience or experience developing, implementing and evaluating population health programs with five years in a supervisory role.
- DATA CENTRIC - Ability to turn data into meaningful information.
- Exceptional organizational skills
- Detail oriented
- Ability to be strategic and a visionary
- Strong leadership experience, specifically leading LARGE teams
- Exceptional communication skills
- Ability to foster and embrace an agile environment, knowing how to prioritize work while maintaining flexibility
- Multistate compact RN license
- Proficient in standard case management experience
- Proficient in Excel, PowerPoint, and Visio
What Blue 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.
Our comprehensive benefits package includes:
- 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
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies, theaters, zoos, theme parks and more
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 be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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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