The hiring range for this role is:
$172,326.41 - $282,228.46
This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonusincentivepay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Job Description Summary:
Provides strategic leadership and innovative practices for the Federal Employee Program, aiming to reduce care delivery costs while improving quality metrics. Oversees FEP's medical/surgical benefit management, including value-based care, case and disease management, and mental health services. Advises stakeholders, enhancing plan engagement, and promoting health equity. This role focuses on developing clinical programs, analyzing health outcomes, managing population health, and fostering a culture of excellence, teamwork, and continuous learning. Additionally, it includes mentoring staff to build a positive, collaborative work environment.
Responsibilities include but are not limited to:
- Direct the creation and development of case and disease management strategies, mental/behavioral health programs, utilization management, and medical-surgical coding to boost engagement, outcomes, and operational efficiency; ensure uniform program delivery nationwide, work on cost containment, and promote health equity; guide cross-functional teams to execute clinical initiatives and streamline claims and invoice processing. 30%
- Collaborates cross-functionally to launch equity initiatives, develop programs, recommend system changes, and create performance metrics; ensures alignment across delivery systems for new clinical products and services; oversees administration, compliance, and stakeholder readiness for complex benefits and clinical programs. 25%
- Provides leadership and expertise for FEP and BCBSA initiatives, guides innovative clinical and quality health outcomes initiatives, ensures consistent delivery of clinical services across vendors, and represents clinical interests in benefit proposal negotiations with the Office of Personnel Management. 25%
- Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals. 20%
Required Education, Certifications and Experience:
Education:
- Required Bachelor's Degree in allied Health, Pharmacy or Business or equivalent work experience. Clinical degree a plus (RN, MSN, RPH, PharmD, MD, LPN)
Experience:
- 12+ Years health Plan experience (or equivalent clinical experience) Required
Knowledge Skills and Abilities:
- Technical proficiency with information technologies (e.g. Microsoft Office)
Experience rolling out new programs and operational experience in managing programs and budgets - Understanding of health care/managed care industry and environment including health care issues, reform, competition, ancillary provider trends and MCO industry trends
- Excellent interpersonal skills and ability to work with and within a cross-functional team environment
- Ability to work within all levels of organizational and government and vendors
- Excellent verbal, presentation and written skills as well as the ability to establish and manage multiple priorities
- The ability to gain various viewpoints and arrive at critical decisions to ultimately develop and implement strategic initiatives
- Proven ability to lead motivate and organize teams and knowledge
- Technical proficiency with information technologies (e.g. Microsoft applications, Winframe, account management and group ware) to enable the management of on-going communication
Additional information:
- Minimum of 12+ years’ Health Plan experience (or equivalent clinical experience)
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