Population Health Strategy Manager

Blue Cross & Blue Shield of Rhode Island•Providence, RI

About The Position

The Population Health Strategy Manager identifies and leads new capabilities and initiatives to improve health outcomes, member support, and total cost of care for low-income Medicare members. The role oversees program execution and collaborates with internal and external partners to develop models that improve the member experience and health outcomes while reducing healthcare costs. The manager is accountable for low-income population health management initiatives and their performance. The role requires developing a deep understanding of the needs and risk factors of low-income Medicare members, as well as the ecosystem of providers, community organizations, government agencies, and private entities that influences members’ healthcare experiences and outcomes. It develops targeted population health capabilities from concept through deployment, using data and analytics to assess options, tradeoffs, and results. The manager works closely with the D-SNP clinical team and a broad range of internal and external stakeholders to support program development and operational execution.

Requirements

A combination of education and related work experience.
Seven to ten years of experience in healthcare program development, consulting, process improvement, operations management, and strategy.
Relevant healthcare experience, preferably in a health plan or healthcare provider environment, with experience serving Medicaid or dual-eligible populations.
Knowledge of managed-benefit strategies, utilization-review techniques, healthcare financing and delivery, health plan operations, and healthcare infrastructure design.
Ability to collaborate effectively while navigating complex situations.
Ability to think creatively, drive innovation, and combine creative problem-solving with a practical operational perspective.
Ability to motivate, lead through influence, and guide diverse stakeholders toward a common goal or solution.
Ability to translate business strategy into action-oriented deliverables and measurable results.
Strong business acumen and political savvy.

Nice To Haves

Master’s degree in a relevant field, such as an MBA, MHA, or MPA.
Knowledge of population health management fundamentals, CMS Medicare Advantage programs, healthcare finance and reimbursement methodologies, and healthcare quality-improvement strategies.

Responsibilities

Develop an understanding of low-income Medicare members’ needs, social, behavioral, and medical risk factors, and the organizations influencing their healthcare experiences and outcomes.
Design data-informed solutions to reduce medical expenses for targeted low-income cohorts, including members with serious and persistent mental illness.
Assess vendor-partner and internally developed options to improve medical expenses and the member experience.
Strengthen external relationships, introduce shared initiatives, and track outcomes, including data-sharing opportunities with Certified Community Behavioral Health Clinics.
Develop population health capabilities from concept through deployment, evaluating care management, utilization management, vendor relationships, and other clinical strategies.
Work with the D-SNP clinical team to incorporate frontline insights and support operational execution.
Use data and analytics to evaluate programmatic, operational, and economic tradeoffs and develop recommendations.
Partner with internal stakeholders, external stakeholders, and other appropriate parties to support successful program development and deployment.
Perform other duties as assigned.