Director, Population Health Applications

Capital Blue Cross•Harrisburg, PA

3h•Hybrid

About The Position

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” This role is responsible for the strategic and operational management of Capital Blue Cross’s portfolio of clinical technology solutions and the business processes they enable. The Director is responsible specifically for Care Management, Clinical Vendor and Utilization Management software applications and their related technology ecosystems. This role ensures alignment through workflow design and solutions co-development with cross functional teams. The role functions to triage, coordinate and operationalize product needs and enhancements in tight coordination with strategic leadership, operations and technical subject matter experts. The Director represents population health on data governance committees while also partnering with analytics teams to co-engineer insights that depend on underlying data & business logic.

Requirements

Functional experience and comfort leading with contemporary Product Management practices (Agile, Kano, Lean etc.).
Strong decision making, problem solving, and presentation skills (verbal & written)
Ability to analyze complex problems and issues, determine impact, and develop business solutions or recommendations for changes.
Ability to communicate complex issues effectively and across a range of stakeholder skillsets to foster cross-functional relationships and tactical alignment.
Must be comfortable with change and possess the ability to lead and motivate individuals to execute in the face of rapidly evolving requirements without losing sight of strategic goals.
Working knowledge of contemporary healthcare clinical operations workflows.
Working knowledge of Health Plan priorities including HEDIS and Risk coding.
Knowledge of contemporary and evolving healthcare technology capabilities including a propensity to learn and apply AI/ ML/ automation solutions to solve business problems.
Minimum of 6 years in a formal Product Management role and/ or leadership at the intersection of healthcare operations and health technology management.
Minimum of 3 years of supervisory experience.
Master’s degree in a related field is required.

Responsibilities

Accountable for the daily operations of Capital’s suite of care management, utilization management and vendor solutions. This includes coordinating system upgrades, engineering new use cases or workflows, liaising with vendors, clearly documenting requirements and testing changes before production.
Design and develop the business strategy and requirements needed to monitor and dynamically manage member clinical interventions across multiple current and future use cases. Accountable for engineering systems that can trigger the right clinical interventions for the right member at the right time.
Partners with operations leaders to plan for and incorporate AI/ ML and automation solutions where appropriate and updates strategy as vendor capabilities evolve.
Works with enterprise leadership to ensure that requests are appropriately prioritized and cross-functional dependencies are identified and managed.
Responsible for coordinating resources and aligning on product changes by maintaining an intake, triage and strategic roadmap project queue. Regularly reports on project status, risks and resource capacity to inform dynamic adjustments to project priority and timeline. Maintains project portfolio status and visibility across all impacted stakeholders.
Partners with analytics colleagues to ensure that data emanating from population health applications is appropriately governed, and that clinical workflows are generating the expected discrete data to support analytics and reporting.
Partners with operations management to develop reports and embed insights that aid productivity management and improve the efficiency of clinical workflows.
Supports the bi-directional movement of files to and from vendors to support effective member engagement, minimize administrative waste, and maximize outcomes across Quality, Risk and Total Cost of Care.
Responsible for evaluating the impact of regulatory changes on technology solutions and workflows, including risk mitigation and compliance with CMS, NCQA, FEP, BCBSA or other regulatory body mandates.
Develops and calibrates agile workflows to manage team productivity and maintain high quality user experience for the clinical team members.