Population Health and Manager of Post Acute Care Program Lead

BlueCross BlueShield of South Carolina • W@H South Carolina, SC

2d • Remote

About The Position

We are currently hiring for a Population Health and Manager of Post Acute Care Program Lead to join BlueCross BlueShield of South Carolina. In this role as a Population Health and Manager of Post Acute Care Program Lead, you will be responsible for the development and management of various health management programs to include Case Management, Disease Management, Utilization Management, Behavioral Health, and Healthcare Development. You will assess the impact of programs, which may include performing cost-benefit/feasibility analyses, performing market research assessing corporate competitiveness, and providing strategic direction for reporting, including design, analysis, and validation of outcomes and ROI. The Population Health and Post Acute Care Program Lead plays a critical role in managing members transitioning from acute hospital care into long term or post-acute care settings. On a daily basis, the role involves coordinating with 100 or more individuals, including care facilities, healthcare providers, members, and family members, to ensure safe, effective, and efficient care transitions. Members in this population typically do not return directly home after discharge, requiring close oversight of placement decisions and ongoing care. This position is highly cost containment focused, as both the choice of post-acute facility and the length of stay directly affect healthcare spend. The Program Lead monitors utilization closely, ensuring members receive appropriate care in the most cost-effective setting while avoiding unnecessary days in high-cost facilities. The role includes coordinating and documenting extensions of care, developing medical and operational justifications, and arranging safe transitions back home when clinically appropriate. Equally important is the management of care quality. The Program Lead evaluates member outcomes, documents complications and complaints, and assesses the efficiency of care provided across facilities. This includes analyzing whether similar outcomes are achieved in shorter versus longer stays and identifying opportunities for improvement. Strong analytical and data skills are essential. The role requires building, monitoring, and interpreting dashboards, identifying core measures, applying benchmarks, and holding facilities and partners accountable for performance. Ideal candidates bring excellent communication skills, strong analytical ability, an understanding of utilization benchmarks, and at least two years of case management experience, thriving in a fast-paced, data-driven healthcare environment.

Requirements

• Bachelors in a job-related field.
• Graduate of Accredited School of Nursing. (Equivalency not applicable for the Celerian Group. Bachelor's degree required.)
• 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.
• 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.
• Microsoft Office.
• If RN, active, unrestricted RN licensure from United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR if Social Worker or Counselor, active unrestricted licensure as Social Worker or Counselor from the United States and in the state of hire (for Div. 75 only).

Nice To Haves

• At least 2 years of case management experience
• Must be able to apply benchmarks effectively and hold others accountable for meeting performance standards.
• Must have exceptional coordination and communication skills.
• Must have a high degree of analytical skills.
• Must have keen attention to detail and exceptional time management skills.

Responsibilities

• Develops, implements, evaluates, and maintains health management programs.
• Positions BCBSSC to compete effectively with other companies.
• 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.
• Establishes reporting mechanism that details clinical outcomes, utilization statistics and ROI.
• 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.

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
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level