Job Description |
Director Government Care Programs - 2447
Job duties include but are not limited to the following:
• Work to advance strategies for government care programs including the exhanges.
• Develop Medicaid Up focused programs
• Administer the Grievance and Appeals program requirements
• Enhance FEP program and reporting capabilities inclduing post service claims review.
• Support development and management of Medicare Specific program initiatives.
• Collaborate with Senior Medical Director and Sales/Marketing to develop innovative, clinically appropriate benefit design and services.
• Maintain and develop relationships with BCBS Association.
• Build trust by demonstrating high ethical standards and personal integrity and implement strategies aligned with Florida Blue’s mission.
• Develop and improve government Clinical Care Programs process and performance standards
• Provide oversight of the government Clinical Care Programs
• Develop and maintain consistent decision and communication process for government Clinical Care Program enhancements and new developments
• Review and direct the development of policies, procedures, standards and training
• Coordinate with Member Service Organization (MSO), Retail Health partners to seamlessly integrate member empowerment and engagement programs
• Review and redesign as necessary provider and member engagement for a member centric approach
• Manage and oversee vendor for the Health Risk Appraisal
• Work with Clinical Quality to ensure consistent application of benefits and criteria
• Work with Care Management and Quality Leadership to identify linkages with other processes, such as Case Management flags or Inform and Educate opportunities
• Provide appropriate monitoring and evaluation and controllership to ensure desired business results are met.
• Manage shared scorecard to optimize performance.
• Identify skill gaps that ensure the Staff is adequately prepared to address changes in the delivery of healthcare.
• Lead, develop, motivate and manage a high performing team to meet organizational goals and objectives.
• Provide ongoing coaching and development to successfully lead team.
• Lead succession planning for team to prepare for potential mobility up or across the organization
• Bachelor’s degree in Healthcare management or related field, or equivalent experience.
• 7 years experience in healthcare administration and operational positions in healthcare venues.
• Program Development Skills
• Critical Thinking Skills
• Current RN license
• Managed care experience
• 5 years management experience, inlcuding experience managing production work, budget and personnel management experience and experience managing operations
• Strong verbal and written communication skills
• Grievance and Appeals
• Post Service Medical Review
• Case Management
• Strong Medicare Advantage and/or FEP experience
• Including an understanding of compliance requirements
Business Specific Criteria (preferred skills):
• Advance degree
• Demonstrated change leadership abilities
• Proven change leadership
• Strong presentation skills
• Demonstrated use of the tools and principles of continuous improvement.
• Understanding of BCBSF organization, structure, policies and procedures.
• Knowledge of healthcare and insurance industry, BCBSF products/benefits and managed care programs
Primary Location Ft. Myers
Organization Blue Cross Blue Shield of Fla
Posting Deadline Ongoing
Blue Cross Blue Shield of Florida - 24 months ago
Your Health Solutions Company
We’re here for the people of Florida with every aspect of their health and wellness—from the...