Health Care

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BlueCross BlueShield of TNChattanooga, TNThe incumbent works with the Director of Medicare Advantage and Sr. Manager, CCIP, Medical Management and Compliance to support the development, implementation and monitoring of health management programs within the Medicare Advantage Health Management department. The incumbent will serve as the primary contact with Medicare Advantage Operations, the Government Product Development staff and Commercial Marketing staff in development of new products offered to individual Medicare beneficiaries as well as potential commercial retiree accounts as they relate to Health Management programs. The incumbent will be expected to establish relationships with multiple internal departments within BCBST in order to collaborate with them as products, programs and processes (including system configuration) are designed and implemented.  A key responsibility will be active involvement in coordinating operational development of these programs and performing analysis to recommend new Health Management programs or revisions to current Health Management programs.   Functions:• Serve as the primary contact with Medicare Advantage Operations, the Product Development department and Marketing in the development of new Medicare Advantage programs, for potential individual beneficiaries as well as groups as they relate to Health Management programs. • Conduct research and analysis of existing CMS demonstrations as well Medicare Advantage competitors to recommend the development and implementation of new health management programs for Medicare Advantage as well as redesign of existing programs, upon evaluation. • Coordinate operational development of these programs with all BCBST divisions as well as departments within the Operations departments • Serve as the lead to direct the implementation of the Medicare Advantage Health Management programs, which includes coordination with Marketing, Account Management, Medicare Advantage Sales, CMS, I.S., BEG, Quality Management Medicare Advantage Regulatory Compliance, Commercial and BlueCare Care Management departments, Pharmacy department, external vendors, and all Medicare Advantage Operations departments. • Provide responses to RFPs for potential group business. • Liaison for the Director and Sr. Manager with external vendors and partners including BCBS of Alabama and PCSI (PBM) • Management and coordination of major projects within the Medicare Advantage Health Management department as assigned by the Director of Medicare Advantage and Sr. Manager, CCIP, Medical Management and Compliance. • Represent Director and Sr. Manager on numerous key corporate committees and workgroups with the knowledge and authority to make decisions, as necessary. • Maintain excellent understanding of all CMS requirements, directives, change orders, etc. for the Health Management department to ensure process development is compliant with these requirements. • Oversees and monitors initiative progress to identify opportunities for improvement and leads in the development of recommendations and evaluation of possible solutions. • Initiate and coordinate the development of operational and account specific reports.Qualifications:• Registered Nurse or Bachelor's degree in a business or health related discipline or equivalent work experience required. Registered Nurse must have an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. • Minimum of 3 years experience in medical management programs; previous experience with case or disease management preferred. • Minimum of 5 -7 years experience in a professional staff or leadership position • Proven leadership skills, problem-solving ability and ability to plan, organize and coordinate the implementation of large projects that span divisional lines within BCBST as well as external parties such as vendors, state or federal agencies. • Strong analytical, planning, organizational and research skills are required. • Self -directed with excellent interpersonal skills, a team player • Proficient with the use of a variety of software applications (e.g.., Microsoft Word, Excel, PowerPoint, Project, Visio) • Facets and CareAdvance experience preferred. • Project management experience preferred. Please apply via our career site at:https://www.bcbst.com/about/careers/openings/