Population Health Strategy Manager

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

7d•$116,900 - $187,100

About The Position

The Population Health Strategy Manager identifies and leads 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 approaches that improve member experience and health outcomes while reducing healthcare costs. It is accountable for low-income population health management initiatives and their performance. The manager develops a deep understanding of the needs and risk factors affecting low-income Medicare members and the broader network of organizations that influence their healthcare experiences. The role designs data-informed solutions, evaluates internal and vendor options, builds external relationships, and develops population health capabilities from concept through deployment. It also works with the D-SNP clinical team and uses data and analytics to assess tradeoffs and make recommendations. BCBSRI supports remote and hybrid work arrangements, depending on the role. Remote employees may reside in specified states, subject to Human Resources approval. The position is based at an organization headquartered in downtown Providence.

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 a deep 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 for improving 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 targeted 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 parties to support successful program development and deployment.
Perform other duties as assigned.