Sr. Program Manager (Case Management)

Blue Cross Blue Shield of Massachusetts•Hingham, MA

5d•$126,250 - $156,970•Onsite

About The Position

The Senior Program Manager serves as the primary operational leader partnering with the clinical and business operation leaders executing on projects, day to day operations and overall vendor management including MHK – Care Management, Optum (Impact Pro), and Point Click Care (ADT). This role provides project and program management support for internal and external care management initiatives to Health & Medical Management. The primary responsibility is to drive engagement and lead collaboration with Health & Medical Management leaders in strategizing, coordinating, and implementing changes within the Health Management department or their assigned Care Management areas, often serving as the operational lead. Accountable for end-to-end operations management of MHK, Impact Pro, and Point Click Care, including leading release management, troubleshooting issues, and driving system optimization. Additionally, responsible for driving member identification strategic initiatives, collaboration with Digital Care Management leaders, and Medicare Stars to enhance program effectiveness and outcomes. As an integral part of the HMM Core Application Team, the Senior Program Manager collaborates with internal and external areas across the company. The Senior Program Manager also works collaboratively with their peers of analysts, project managers and technical consultants. With a deep understanding of both business and clinical processes, the Senior Program Manager serves as a key liaison, translating operational concerns into actionable insights and advocating for Care Management and clinical teams with vendor partners.

Requirements

Experience managing clinical operations, including staffing forecasts, team performance metrics, reporting, and process improvements.
Proven ability to develop and execute strategic initiatives using both qualitative and quantitative analysis.
Strong multitasking skills in a fast-paced, dynamic environment.
Exceptional communication and presentation skills for both large and small audiences.
Strong interpersonal skills with the ability to engage physicians, nurse reviewers, and administrative leaders at all organizational levels.
Proven leadership in team building, consensus-building, and stakeholder engagement.
7+ years of experience in a managed care environment required.
Demonstrated ability to lead, motivate, and manage direct reports, cross-functional teams, and matrixed relationships.
Established track record of handling ambiguous, high-stakes projects requiring autonomy and sound decision-making.
Strong enterprise-wide relationships and ability to influence key stakeholders.
High school degree or equivalent required unless otherwise noted above

Nice To Haves

7+ years of healthcare leadership experience preferred.
Bachelor’s degree (BA/BS) in Healthcare, Business, Health Management/Administration, or a related field preferred.

Responsibilities

Drive operational workflow improvements by analyzing, identifying, and implementing efficiency opportunities.
Engage and influence senior leadership, external vendors, and consultants to align on strategic priorities and operational goals.
Spearhead complex programs and projects, ensuring strategic alignment, meticulous planning, and seamless execution.
Leverage data-driven insights to conduct high-level strategic, qualitative, and quantitative analysis, resolving complex business challenges.
Develop and execute innovative solutions that enhance program effectiveness, align with market demands, and drive quality improvements.
Lead large-scale, cross-functional initiatives that drive operational excellence, process optimization, and business transformation.
Own and oversee assigned programs and vendor relationships, collaborating with clinical leadership to achieve financial, operational, and clinical goals.
Optimize business processes through system configuration, integration, and performance to drive efficiency and scalability.
Partner with technical consultants and business leaders to align on strategic objectives and implement both system-based and process-driven solutions.
Govern care management monthly vendor release cycles, ensuring timely deployment, seamless integration, and proactive issue resolution.
Facilitate and lead program meetings, setting agendas, documenting key decisions, and driving follow-up actions.
Manage and prioritize maintenance requests, system enhancements, and defect resolution to support continuous improvement.
Ensure system stability by proactively monitoring performance, executing configuration updates, and validating fixes.
Advance member identification strategies, collaborate with Digital Care Management leaders, and drive Medicare Stars initiatives to enhance program effectiveness.