Director/Sr Director Government Medical Programs

About the position At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. This position requires you to work in our office in Omaha, Nebraska. This position is a key partner in developing and implementing strategies to ensure efficient and effective performance of government medical programs including ACA and Medicare Care Advantage Care Management. This role will collaborate and work closely with the market segment leaders for ACA and MA business. The incumbent will provide leadership in developing initiatives to improve the safety, efficiency, effectiveness and accessibility of care and services provided to members, improve population health, and reduce per capita cost of care. Responsibilities will include ensuring regulatory, accreditation and association requirements are met as they pertain to the organization's government programs and other mandated improvement activities. There will be a strong focus on current trends, evidence, and models to advise and determine appropriate strategic priorities. This position works closely with the medical, pharmacy, product, marketing, claims, network, and service teams to deliver innovative medical management programs and remain compliant with regulatory standards (URAC, CMS, Federal/State requirements). In addition, this individual will establish productive relationships with provider community across the state. The relationships assist in facilitating optimal care delivery, population health management, and high-quality care for our members. This role serves as an expert leader to provide guidance and direction, and strategic transformation in the coming years for the nursing staff and external partners.

Responsibilities

• Advise senior leaders in the development of departmental and organizational strategy and progress toward goals.
• Foster the development of high performing teams through talent recruitment and career development plans.
• Facilitate a positive work environment that fosters ethical decision making, innovation, customer focus, respect, trust, and collaboration.
• Act as an advisor and engage with other teams to lead the development and execution of improvement initiatives.
• Develop key strategic goals for medical management programming in conjunction with the Chief Medical Officer.
• Oversee teams responsible for utilization management, case management, and appeals.
• Integrate medical and policy strategies, programs, and products to support improving member care.
• Collaborate with providers and ACOs in coordinating medical management programs.

Requirements

• Bachelor's degree in business or a related field of study or equivalent experience.
• Minimum of 7 years' experience with a health care payor, medical management programs or a related field.
• Experience building and leading teams and implementing strategies.
• Experience mentoring and coaching leaders.
• Demonstrated previous experience working in Medicare Advantage and Managed Care Organizations.
• Prior Medicare Advantage medical management and utilization management experience at a leadership level.
• Demonstrated experience delivering business results.
• Experience with data-driven decision making.
• Regular travel to Omaha required.
• Ability to work in a fast-paced, dynamic environment.

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