Manager Disease Management & Wellness Programs

Blue Cross and Blue Shield of Kansas•Topeka, KS

3d•Hybrid

About The Position

Under the direction of the Director Care Management Programs, the Manager Disease Management and Wellness Programs is responsible for designing, implementing, and overseeing Disease Management and Wellness programs that promote member health, improve quality of life, and reduce healthcare costs across all lines of business. The role ensures programs meet the needs of members, providers, employer groups, and national accounts, including the Federal Employee Program (FEP). The Manager oversees health interventions such as digital tools, outreach campaigns, telephonic support, and community-based initiatives. The position manages daily operations, program evaluation, and quality improvement activities, including URAC accreditation and HEDIS measures. It oversees staff, vendor relationships, data systems, departmental plans and budgets of approximately $2 million, and program performance. The position is eligible to work hybrid or onsite in accordance with the Telecommuting Policy. Applicants must reside in Kansas or Missouri, or be willing to relocate as a condition of employment.

Requirements

Bachelor’s degree in Nursing, Healthcare Administration, Health Services Management, Public Health, or a related field.
Current, active, unrestricted Registered Nurse licensure in Kansas.
At least 7 years of broad clinical experience in healthcare settings.
At least 5 years of experience in the health insurance industry.
At least 5 years in a management or leadership role.
Knowledge of applicable state and federal guidelines and requirements for health programs, including Kansas Insurance Department incentive guidelines and FEP operational guidelines.
Understanding of member and provider contracts across lines of business and how contractual requirements translate into program operations.
Knowledge of healthcare accreditation and regulatory frameworks, including NCQA and URAC, and ability to interpret standards to support compliance and quality improvement.
Knowledge of outcomes measurement methodologies, performance metrics, and quality reporting.
Strong analytical and problem-solving skills, including the ability to interpret healthcare and program data to guide decisions.
Excellent interpersonal skills and ability to build and maintain relationships with internal partners, external vendors, providers, employer group leaders, and members.
Advanced written and verbal communication skills, including the ability to present complex information clearly to diverse audiences.
Ability to manage complex projects and competing priorities with attention to detail, adaptability, and a results focus.
Ability to sit for extended periods while working at a computer, with intermittent standing and walking throughout the workday.
Ability to communicate effectively in person and via phone or video conference, including participating in meetings for extended periods.
Ability to occasionally lift, carry, push, or pull up to 25 pounds.

Nice To Haves

Certification as a Case Manager (CCM) and/or Certified Diabetes Care and Education Specialist (CDCES).
Additional certification in healthcare quality.
Demonstrated experience applying statistical methods to quality management or healthcare research.

Responsibilities

Manage staff and team operations, including hiring, performance management, policy enforcement, disciplinary action, termination processes, compliance, team development, and accurate documentation.
Lead the design, implementation, and evaluation of disease management, wellness, preventive care, and chronic condition programs aligned with corporate goals and quality and accreditation standards, including HEDIS, URAC, and STARS.
Analyze health risk, claims, and program data to guide population health strategies, prioritize initiatives, and inform program development and continuous improvement.
Develop, validate, and monitor performance metrics, outcomes, and return on investment; prepare and present reports to internal committees and external stakeholders, including employer groups and national accounts such as FEP.
Oversee department data systems and platforms, including vendor-supported tools, reporting capabilities, and prioritization of IT projects.
Manage vendor relationships and contracts, including pricing, compliance, and performance guarantees; support accreditation readiness and reaccreditation activities.
Coach, develop, and train a multidisciplinary team to execute program operations, including outreach and engagement strategies.
Escalate and resolve operational and interpersonal issues within the staff hierarchy and between clinical and non-clinical staff.
Collaborate with providers, employer groups, community-based organizations, and internal teams; support RFP/RFI processes and represent the organization on external committees as assigned.
Create and manage annual departmental plans and budgets of approximately $2 million.
Ensure compliance with applicable laws and regulations, internal policies, HIPAA, safety standards, and information security requirements.