Program Manager Clinical Design & Performance (Job Number:11333)
Description
Summary:
This position is responsible for the clinical design and performance activities related to specified current Integrated Health Management (IHM) functions, initiatives and/or new program capabilities. Collaborates closely with Health Economics to research, design and execute ideas brought to the Innovation Office, an initiative of IHM. Collaborates closely with Operations to assess existing functions, such as case management, utilization management and disease management. Identifies and implements efficiencies, value-added opportunities for the functions, and new capabilities for the managed care system platform, including integration of care strategies. Collaborates closely with Operations and Marketing to develop new products, models, and delivery systems for IHM. Develops and implements comprehensive measurement and refinement of clinical performance for defined functions.
Accountabilities:
1. Collaborates in the strategic planning, clinical design and systems build/support for new program development of integrated care management functions. Develops detailed product implementation plans and directs self and others to manage to established timelines with accurate execution to the market.
2. In collaboration with Operations, assesses current specific functional capabilities, and enhances efficiencies and capabilities maintaining outcome integrity.
3. Ensures consistency of specific functions is maintained where feasible, while developing customization to meet unique member and customer needs within Commercial and Government lines of business.
4. Performs in-depth research to identify clinical issues, member experience, and strategic areas of health plan impact. Provide supporting information to build a sound economic model.
5. Maintains functions and new capabilities to eventually culminate to an integrated model with significant components impacting strategic points in the continuum of care. Incorporates design elements that support consumer and provider engagement, promote behavior change, and support self-management of health and wellness.
6. In collaboration with Health Economics, designs the measurement and evaluation of clinical performance. Evaluates programs using these measures and modifies programs based on outcomes, including identification, stratification, interventions, delivery models, and measurement modifications. Also, collaborates closely with IT team to align clinical product builds and deployment timelines.
7. Ensures clinical design meets regulatory compliance with state and federal agencies, and accrediting entities for all program development.
8. Chairs cross-functional program development teams with representation from Operations, Marketing, Regulatory and Compliance, Sales, Account Management, Healthcare Informatics, IT, external parties, and other stakeholders in designing, monitoring and modifying clinical programs. Provides consultation as a subject matter expert as needed to all stakeholders.
9. Provides input into the Clinical Design and Performance budget.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Job duties identified for any function are subject to change at any time. This position is a sedentary job; requires extensive use of the computer. May sit or stand at workstation.
Qualifications
Required Qualifications:
- Bachelor’s degree in health care related field, economics or related field and 5 years health care experience or 9 years of related work experience in lieu of a degree.
- Broad knowledge of the health care industry and managed care.
- Ability to analyze data and transform into program strategies and clinical, financial, and utilization outcome measurement.
- Creative problem solving skills, adapting approach as needed
- Experience in new clinical product development, project management, and quality or process improvement.
- Strong interpersonal skills to collaborate and effectively work through a complex organization to influence change.
- Demonstrated ability in developing and implementing strategic initiatives.
- Proven ability to exercise good judgment and make independent decisions.
- Ability to deal with ambiguity and drive for clarity with a sense of urgency
- Excellent organizational and time management skills.
- Well developed written and oral communication skills with the ability to explain complex information clearly and convincingly.
Preferred Qualifications:
- Master's degree in healthcare related field, business administration or related field.
- Leadership roles in health care delivery/operations.
- Knowledge of data analysis and information technology in a business environment.
BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
This position is responsible for the clinical design and performance activities related to specified current Integrated Health Management (IHM) functions, initiatives and/or new program capabilities. Collaborates closely with Health Economics to research, design and execute ideas brought to the Innovation Office, an initiative of IHM. Collaborates closely with Operations to assess existing functions, such as case management, utilization management and disease management. Identifies and implements efficiencies, value-added opportunities for the functions, and new capabilities for the managed care system platform, including integration of care strategies. Collaborates closely with Operations and Marketing to develop new products, models, and delivery systems for IHM. Develops and implements comprehensive measurement and refinement of clinical performance for defined functions.
Accountabilities:
1. Collaborates in the strategic planning, clinical design and systems build/support for new program development of integrated care management functions. Develops detailed product implementation plans and directs self and others to manage to established timelines with accurate execution to the market.
2. In collaboration with Operations, assesses current specific functional capabilities, and enhances efficiencies and capabilities maintaining outcome integrity.
3. Ensures consistency of specific functions is maintained where feasible, while developing customization to meet unique member and customer needs within Commercial and Government lines of business.
4. Performs in-depth research to identify clinical issues, member experience, and strategic areas of health plan impact. Provide supporting information to build a sound economic model.
5. Maintains functions and new capabilities to eventually culminate to an integrated model with significant components impacting strategic points in the continuum of care. Incorporates design elements that support consumer and provider engagement, promote behavior change, and support self-management of health and wellness.
6. In collaboration with Health Economics, designs the measurement and evaluation of clinical performance. Evaluates programs using these measures and modifies programs based on outcomes, including identification, stratification, interventions, delivery models, and measurement modifications. Also, collaborates closely with IT team to align clinical product builds and deployment timelines.
7. Ensures clinical design meets regulatory compliance with state and federal agencies, and accrediting entities for all program development.
8. Chairs cross-functional program development teams with representation from Operations, Marketing, Regulatory and Compliance, Sales, Account Management, Healthcare Informatics, IT, external parties, and other stakeholders in designing, monitoring and modifying clinical programs. Provides consultation as a subject matter expert as needed to all stakeholders.
9. Provides input into the Clinical Design and Performance budget.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Job duties identified for any function are subject to change at any time. This position is a sedentary job; requires extensive use of the computer. May sit or stand at workstation.
Qualifications
Required Qualifications:
- Bachelor’s degree in health care related field, economics or related field and 5 years health care experience or 9 years of related work experience in lieu of a degree.
- Broad knowledge of the health care industry and managed care.
- Ability to analyze data and transform into program strategies and clinical, financial, and utilization outcome measurement.
- Creative problem solving skills, adapting approach as needed
- Experience in new clinical product development, project management, and quality or process improvement.
- Strong interpersonal skills to collaborate and effectively work through a complex organization to influence change.
- Demonstrated ability in developing and implementing strategic initiatives.
- Proven ability to exercise good judgment and make independent decisions.
- Ability to deal with ambiguity and drive for clarity with a sense of urgency
- Excellent organizational and time management skills.
- Well developed written and oral communication skills with the ability to explain complex information clearly and convincingly.
Preferred Qualifications:
- Master's degree in healthcare related field, business administration or related field.
- Leadership roles in health care delivery/operations.
- Knowledge of data analysis and information technology in a business environment.
BlueCross BlueShield of MN is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. BlueCross BlueShield of MN is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job