Job type full-time
Full job description
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 2.9 million membersWe’re committed to reinventing health care to improve health for our members and the communityWe hope you`ll join usPlease note that effective 11/23/2021, all associates must be fully vaccinated for covid19 unless legally entitled to a reasonable accommodation related to religious or medical exemptions.
How is this role important to our work?
This position will manage and monitor the contract language and expectations for the dhs families and children`s contract and be the primary behavioral health, public health and general county representative for committee/work group representation at county, other government and the minnesota department of human servicesThe incumbent will foster positive relationships with other external partners through participation in community work groups, and other appropriate venuesThis position will actively find opportunities to positively impact behavioral health, public health and general eligibility issues with the service provision of minnesota health care programs (mhcp) populations and develop collaboratives within minnesota communities, using the strengths of our health plan, community-based providers and other service providersThis position will be a leader with vision and influence the strategies and initiatives of blue cross to compliment statewide directives and priorities.
A day in the life:
Manage and lead complex, cross-functional initiatives within gp and the matrixed organization that deliver high quality solutions, contribute to the business performance results and meet state and federal requirementsCross functional teams include health management, service, claims, network management, and benefit set up.
Lead solution efforts for defined issues, new benefits and legislative requirements including distribution of information to various blue cross divisionsDirects and/or consults with staff and cross-functional teams in analyzing current and new processes, system and interfaces analysis and information flows as they relate to implementations process and regulatory changes.
Build and foster relationships with counties and external partners related to the quality of behavioral health services and other health care benefits provided to mhcp members and the residents of minnesota such as the department of human services, mn department of health, county staff, advocacy groups, consumers and community service providers.
Represent the organizations behavioral health and general public health strategies and initiatives to community leaders and the general public and serve as a leader with vision and expert on assigned program issuesResponsible for representing blue cross in all external partner committees for behavioral health, public health, human services and other health care related issues including, mn council of health plans, county departments, dhs, and the mn department of health.
Independently identify priority alliances and community collaboratives that advance the quality of health care services and facilitate the collaboration processes in concert with internal and external partners.
Build and maintain subject matter expertise regarding state and dhs regulations and clinical standard methodologies specific to behavioral health, public health and other covered mhcp servicesRepresent and incorporate knowledge of health care state/community trends and needs into bcbsmn capabilities for discussion and implementation as appropriate.
Lead, participate and represent behavioral health strategies and interests with internal work groups specific to government programs product initiatives and clinical work groupsAssess, develop and initiate new program services in response to documented need in accordance with adequate feasibility studies and implementation plans.
Develop and maintain an understanding of state-based initiatives and processes for implementation at blue cross and within the communityIdentify potential strategic opportunities and alliances to improve behavioral health services and bring differentiation in the market place; champion within bcbsmRepresents gp product in strategy meetingsThis position ensures strategies being proposed are viable and attainable for gp and matrixed organization.
Lead implementation team to coordinate downstream operational activities needed to ensure product strategy and regulatory changes are rolled out into productionManages the benefit design and implementation of all new contract established health benefits.
In partnership with affordability of care staff assess, develop and initiate new program services in response to documented need in accordance with adequate feasibility studies and implementation plansManage program eligibility including; strategy, message development and delivery to counties regarding complex medicaid eligibility issues.
Participate in applicable strategic conferences and health fairs.
Be an inspiring leader and influence the strategies and initiatives of blue plus to compliment statewide directives and priorities of our county and community partnersPotential supervision of staff assigned to gms medicaid critical initiatives (future).
Nice to have:
Masters degree in behavioral health or health administration.
Holds an unconditional licensure in a behavioral health practitioner specialty.
Experience and in-depth knowledge of minnesota medicaid benefits and business models.
County experience in the human services field.
Required skills and experiences:
Bachelors degree in business, human services or health care related field and 7 years of relevant health care industry experience or experience working with the county human service delivery system (social services, public health, or eligibility) or 9 years relevant health care industry experience in lieu of a degree.
7 years of experience in leading complex health challenge solution generation within a multi-stakeholder and community-based collaborative framework.
Knowledge of behavioral health, human services or public health care delivery systems, other community-based services and minnesota community standards.
Health insurance industry knowledge including managed care, reimbursement, provider services, care management, and medical and behavioral health benefits.
Strong relationship management skills to collaborate and effectively work with partners to influence change.
Exceptional speaking and presentation skills; ability to manage communication and follow up in sometimes difficult customer relationships.
Excellent organizational, change management and time management skills.
Well-developed written and oral communication skills with the ability to explain complex information clearly and convincingly.
Effective independent leadership and facilitation capability, proven skills in critical thinking and ability to pursue goals with tenacity and sense of urgency.
Travel throughout minnesota will be expected.
Demonstrated ability to manage multiple complex issues or initiatives.
Proven ability to work independently and in a team environment.
Make a difference
Blue cross is an equal opportunity and affirmative action employer that values diversityAll 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 firstname.lastname@example.org.
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.