Cost Containment and MLR Optimization Program Lead

About the role

The Cost Containment and MLR Optimization Program Lead at BlueCross BlueShield of South Carolina is responsible for the development and management of various health management programs including Case Management, Disease Management, Utilization Management, Behavioral Health, and Healthcare Development.

Responsibilities

• Achieves positive return on investment through oversight of new product/technology development and promotion of service enhancement strategies to increase customer retention.
• Develops and conducts health management presentations to management, internal and external customers that are informative and customized to meet health plan and customer needs.
• Develops and maintains specific reporting to include tracking of efficacy, clinical/financial outcomes, research analysis, and the accuracy/timeliness of data collection.
• Provides leadership and direction to staff through employee development, management training, and budget oversight.
• Develops, implements, complies with and promotes staff adherence to corporate and department policies, procedures, and performance and communication standards.
• Complies with and monitors 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.

Requirements

• Bachelor's degree in a job-related field or equivalent education.
• 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.

Qualifications

• Working knowledge of word processing, spreadsheet, and presentation software.
• Ability to understand and communicate healthcare policy.
• 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.

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.

Benefits

• 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.
• Education Assistance.
• National discounts to movies, theaters, zoos, theme parks and more.