Government Programs Partner Relations Consultant (Job Number:7851)
Description
Summary:
Responsible for county and non traditional provider relations that support government programs wide range of Medicare and Medicaid products. Assists in the development of and provision of semi annual delegate training, conducting annual care plan audits and ensuring post-audit follow up, serving as a regulatory and Blue Plus subject matter expert/resource to county and non traditional providers, and providing delegate oversight.
Accountabilities:
- Develop and maintain cross-functional business relationships with internal and external partners in order to effectively manage product lines, drive product-related process improvement and provide leadership of collaborative teams that cross departments and BCBSM business units, such as Network Management and Integrated Health Management, and community provider partners. Staff internal and external workgroups.
- Maintain technical and regulatory Government Programs product expertise and serve as product resource and expert to internal and external partners. Provide day to day product management oversight for operations and budget.
- Assist in the development of training curriculum and provide of semi annual delegate training both face to face or through webinar technology.
- Conduct annual care plan audits, including assisting in the development of the audit protocol and process design and required post audit follow up.
- Implement and maintain a comprehensive delegate oversight program to ensure that contracted entities adhere to contract and compliance requirements and, in consultation with Manager, impose corrective and/or disciplinary action plans when required. Foster effective delegate relationships through facilitation, coaching, mentoring, and teaching.
- Assist in the development of delegate guidelines, forms, resources, and process improvement initiatives.
- Participate in product related promotional activities such as conference booths, ad hoc trainings, and child and teen check-up/lead screening outreach activities.
Position requires traveling up to 50% of the time.
Qualifications
Required Qualifications:
- Bachelor's degree and 5 years experience in health care, social services, or related field, or 9 years of work experience in health care, social services, or related field in lieu of a degree.
- Working knowledge of current managed health care field and key competition.
- Ability to build strong working relationships with vendor partners and internal and external business partners.
- Ability to work independently and able to handle a variety of responsibilities.
- Strong organizational and time management skills with demonstrated ability to shift priorities as business demands require.
- Excellent facilitation and presentation skills.
- Demonstrated problem solving and analytical skills.
- Ability to think and plan strategically; strong attention to detail.
- Must be self-motivated with strong initiative to learn.
- Strong organizational and communication skills (both verbal and written).
- Process and quality improvement experience.
- Ability to travel.
Preferred Qualifications:
- Registered Nurse, Public Health Nurse, or licensed Social Worker with current MN license.
- Health related auditing experience
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota 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
Description
Summary:
Responsible for county and non traditional provider relations that support government programs wide range of Medicare and Medicaid products. Assists in the development of and provision of semi annual delegate training, conducting annual care plan audits and ensuring post-audit follow up, serving as a regulatory and Blue Plus subject matter expert/resource to county and non traditional providers, and providing delegate oversight.
Accountabilities:
- Develop and maintain cross-functional business relationships with internal and external partners in order to effectively manage product lines, drive product-related process improvement and provide leadership of collaborative teams that cross departments and BCBSM business units, such as Network Management and Integrated Health Management, and community provider partners. Staff internal and external workgroups.
- Maintain technical and regulatory Government Programs product expertise and serve as product resource and expert to internal and external partners. Provide day to day product management oversight for operations and budget.
- Assist in the development of training curriculum and provide of semi annual delegate training both face to face or through webinar technology.
- Conduct annual care plan audits, including assisting in the development of the audit protocol and process design and required post audit follow up.
- Implement and maintain a comprehensive delegate oversight program to ensure that contracted entities adhere to contract and compliance requirements and, in consultation with Manager, impose corrective and/or disciplinary action plans when required. Foster effective delegate relationships through facilitation, coaching, mentoring, and teaching.
- Assist in the development of delegate guidelines, forms, resources, and process improvement initiatives.
- Participate in product related promotional activities such as conference booths, ad hoc trainings, and child and teen check-up/lead screening outreach activities.
Position requires traveling up to 50% of the time.
Qualifications
Required Qualifications:
- Bachelor's degree and 5 years experience in health care, social services, or related field, or 9 years of work experience in health care, social services, or related field in lieu of a degree.
- Working knowledge of current managed health care field and key competition.
- Ability to build strong working relationships with vendor partners and internal and external business partners.
- Ability to work independently and able to handle a variety of responsibilities.
- Strong organizational and time management skills with demonstrated ability to shift priorities as business demands require.
- Excellent facilitation and presentation skills.
- Demonstrated problem solving and analytical skills.
- Ability to think and plan strategically; strong attention to detail.
- Must be self-motivated with strong initiative to learn.
- Strong organizational and communication skills (both verbal and written).
- Process and quality improvement experience.
- Ability to travel.
Preferred Qualifications:
- Registered Nurse, Public Health Nurse, or licensed Social Worker with current MN license.
- Health related auditing experience
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota 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