Cost Containment and MLR Optimization Program Lead

About the role

We are currently hiring for a Cost Containment and MLR Optimization Program Lead to join BlueCross BlueShield of South Carolina. In this role as a Cost Containment and MLR Optimization 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 impact of programs which may include: performs cost-benefit/feasibility analyses, performs market research assessing corporate competitiveness, and provide strategic direction for reporting, including design, analysis, and validation of outcomes and ROI. Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be remote. Our ideal candidate must reside within reasonable proximity to Columbia, SC as they will be required to report onsite occasionally for trainings, meetings, or other business needs.

Responsibilities

• 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.
• To Qualify for This Position, You'll Need the Following:
• Required Education: Bachelors in a job-related field.
• Degree Equivalency: Graduate of Accredited School of Nursing. (Equivalency not applicable for the Celerian Group. Bachelor's degree required.)
• Required Work Experience: 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.
• Required Skills and Abilities: 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.
• Required Software and Tools: Microsoft Office.
• We Prefer That You Have the Following:
• Preferred Work Experience: Prior knowledge/experience with Medicare Advantage.
• Preferred Skills and Abilities: Must be proficient in software systems including SAS, Tableau, and Microsoft Excel.
• Must have excellent communication skills as the candidate will be working directly with vendors and internal teams.
• Must have a high degree of technical and analytical skills.
• Must have keen attention to detail and exceptional time management skills
• Our Comprehensive Benefits Package Includes the Following:
• We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
• 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 We Can Do for You:

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