Senior Care Management Business Consultant

Capital Blue Cross•Harrisburg, PA

9d•Hybrid

About The Position

This role serves as a senior operational, transformation, and business management partner to Care Management leadership and the enterprise’s clinical vendor and program portfolio, in close partnership with Population Health Strategy and Operations leadership. It translates clinical and business strategy into executable operating plans, scalable workflows, technology-enabled capabilities, performance reporting, sustainable implementation practices, and clear value positioning for internal sales partners, brokers, employer groups, and other stakeholders. The position supports complex cross-functional initiatives, business case development, operational readiness, and clinical program business model evaluation. It helps define program value, assess assumptions, compare alternative operating and commercial approaches, and identify practical improvements as programs are evaluated, launched, and scaled. The role strengthens Care Management effectiveness by improving workflow consistency, reducing administrative burden, enabling technology and data adoption, and advancing measurable operational, member, quality, financial, and market-facing outcomes. The position is hybrid and requires onsite work on Tuesdays and Wednesdays in Harrisburg, Pennsylvania. The work environment includes professional office and remote-work settings, frequent virtual and in-person collaboration, and regular use of standard office technology. The role frequently requires sitting, using hands and fingers, talking, hearing, and seeing; occasional lifting or moving of up to 5 pounds is required.

Requirements

Seven or more years of progressively responsible experience in healthcare operations, care management, population health, clinical program operations, process improvement, project management, transformation, implementation, consulting, or health plan operations.
Experience leading complex implementations, workflow redesign, business requirements, stakeholder coordination, change management, and cross-functional initiatives.
Bachelor’s degree in healthcare administration, business administration, nursing, public health, population health, informatics, or a related field.
Ability to lead complex cross-functional initiatives, manage competing priorities, track deliverables, escalate risks, and communicate progress clearly to leadership and stakeholders.
Ability to analyze operational data, develop business cases, define success measures, facilitate decisions, solve problems, and prepare data-informed recommendations.
Ability to partner with clinical and cross-functional leaders to advance transformation priorities while preserving licensed clinical decision-making authority.
Ability to lead workflow redesign, change management, stakeholder engagement, operational readiness, implementation planning, technology enablement, and performance monitoring.
Advanced knowledge of healthcare operations, care management, population health, clinical program operations, process improvement, project management, transformation, and implementation practices.
Knowledge of dashboards, scorecards, business requirements, user acceptance testing, workflow design, resource planning, performance measures, SOPs, and executive reporting.
Familiarity with NCQA, CMS, state regulatory, privacy, documentation, accreditation, quality, and compliance requirements related to Care Management and population health.
Knowledge of product support, value-based care, member engagement, automation, AI-enabled solutions, vendor coordination, and operational transformation.

Nice To Haves

Master’s degree in healthcare administration, business administration, nursing, public health, population health, informatics, or a related field.
Experience developing business cases, project plans, operational analyses, implementation roadmaps, executive updates, and performance measures.
Experience in care management, population health, chronic condition support, transitions of care, complex case management, behavioral health, health navigation, value-based care, or member engagement.
Experience partnering with Product, Sales, Account Management, Analytics, Technology, Quality, Compliance, Provider Network, medical directors, Finance, or external partners.
Project management, Lean/process improvement, change management, Agile, Prosci, Six Sigma, or comparable certification.

Responsibilities

Translate Care Management strategic priorities into operating plans, initiative roadmaps, workflows, timelines, deliverables, resource needs, business and operating model recommendations, and measurable outcomes; identify clinical, strategic, and operational opportunities and provide data-informed recommendations under the direction of the Senior Director of Care Management.
Lead complex Care Management transformation initiatives from planning through implementation, stabilization, and sustainable operational ownership, including business case development, project charters, operational analyses, decision materials, and evaluation of alternative contracting, pricing, risk-sharing, performance guarantee, and delivery constructs.
Develop cost-benefit, savings, ROI, cost-avoidance, implementation, and program value materials to inform prioritization, investment planning, and communication with sales partners, brokers, consultants, employer groups, and other stakeholders.
Partner with clinical leadership to assess current-state workflows and design future-state processes, role clarity, referral pathways, escalation processes, documentation expectations, performance standards, standard operating procedures, playbooks, job aids, training resources, and implementation tools.
Serve as a Care Management business partner for technology, data, automation, AI-enabled tools, reporting, platform optimization, requirements definition, testing, training, operational adoption, and change management.
Coordinate cross-functional partners, including Population Health, Product, Sales, Account Management, Analytics, Technology, Quality, Compliance, Provider Network, Finance, medical directors, and external vendors, to align decisions, manage dependencies, and support implementation readiness.
Serve as business manager for assigned clinical vendor relationships, supporting vendor selection, RFP processes, contract and performance guarantee management, implementation readiness, ongoing performance oversight, issue escalation, and renewal or exit recommendations.
Monitor and analyze operational dashboards, scorecards, productivity measures, engagement metrics, workflow indicators, quality measures, member impact, stakeholder feedback, program trends, and performance results to improve efficiency, reduce administrative burden, strengthen care coordination, and support measurable outcomes.
Support a culture of continuous improvement, accountability, simplification, collaboration, and disciplined execution across Care Management operations.