Manager, HEDIS Hybrid Program Management

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How is This Role Important to Our Work?

This position is responsible for the design, development, implementation, evaluation and ongoing management of programs focused on improved delivery of health care services which lead to the improved health of our members. This position will work with leadership and cross-functional and cross-divisional teams to drive the design and execution required to advance organizational or divisional strategic priorities. The incumbent will ensure the design meets existing and emerging market, provider and member requirements as well as drive the resolution of complex business issues, shape emerging business opportunities/requirements and help the business effectively manage change. The incumbent serves as the liaison between multiple departments within the organization. Incumbent will be required to lead teams across the organization, drive for results within tight deadlines and manage the program management associates within a specific division.

A Day in the Life:

• Drive the development and documentation of design, requirements and implementation required to support initiatives that align with strategic priorities.
• Develop relationships and partner with key resources, both internal and external, to collaborate on the design and ensure all market, member, and provider considerations are factored into the design.
• Drive business decision making process to ensure capabilities, systems and processes meet market expectations and that alternate approaches are vetted and explored.
• Manage related ongoing program management work to understand what is needed to recommend strategy and solutions, while influencing and steering others to accomplish that strategy across multiple complex programs.
• Ensure that appropriate metrics are chosen and that the appropriate measurement, data analysis and evaluation occur for each initiative.
• Develop and continually update program or project plans, timelines and deliverables while coordinating multiple sub-processes to expand and/or improve complex programs.
• Develop and implement a communication plan in conjunction with leadership and to support initiatives, including status and progress updates.
• Stay abreast of changes in the rapidly evolving health care marketplace.
• May perform other duties as assigned.
• Coordinate and oversee the daily operations for HEDIS® abstraction and overreads.
• Plan and facilitate HEDIS initiatives for quality improvement.
• Monitor HEDIS rates daily. Develop and implement strategies to improve rates.
• Recruit, hire, and onboard clinical staff and contractors to support the annual HEDIS project.
• Oversee and manage an offshore HEDIS team, ensuring alignment with organizational goals and quality standards.
• Create and manage the annual HEDIS budget, ensuring efficient allocation of resources and expense management.
• Review and update SOW contracts annually to reflect any changes in scope, deliverables, timelines, and pricing.

Nice to Have:

• Bachelor’s degree in Business, Health Science or related field or Master’s degree in business, nursing, public health, health sciences, health promotion or related field.
• Experience in process improvement.
• Content expertise in the reduction of health risk behavior.
• Experience working in/with diverse racial or ethnic groups and nations.
• Ability to combine traditional health education approaches with policy or other advocacy tactics.
• Experience with HEDIS measures and reporting.
• Experience and proficiency with HEDIS software and electronic health records.
• Experience in analyzing healthcare claims.

Required Skills and Experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 1 year of management experience, leading a team
• Demonstrated organizational relationship management skills.
• Ability to thrive in ambiguity.
• Strong critical thinking skills and problem solving/conflict resolution skills.
• Excellent written and verbal communication skills with strong facilitation, negotiation and presentation skills, adapting approach as needed.
• Attention to detail and time management skills.
• Self-motivated, ability to work independently, and demonstrated ability to work under tight time frames.
• Knowledge of the health care industry, payer business models, business segments and products.
• Proven ability to handle a variety of assignments in a fast paced and complex business environment.
• Proven ability to define problems, collect and analyze data, establish facts and draw valid conclusions.

Role Designation:

Hybrid Remote

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Compensation and Benefits:

$98,600.00 - $133,100.00 - $167,600.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer, please review our benefits page.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.