Blue Health Coach

Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us.

Blue Health Coach

Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.

Major Responsibilities:
Working as a cross-functional member of the Clinical Coordination Senior Management Team focused on innovating and championing process improvements. The Business Leader will mentor and develop staff and will foster a positive and effective working relationships with key external and internal customers.

Provide leadership and management of Blue Health Coach

Develop and implement Coaching/Care Management programs for BCBSMA members.

Provide clinical oversight for Blue Health Coach programs, including budget development, measurement and outcomes development and implementation.

Develop, train and implement clinical and administrative policies and procedures in support of internal BCBSMA and external regulatory requirements.

Develop business plan, vision and values for Blue Health Coach Program.

Develop, implement and manage measurement tools to identify continuous process improvement and operational metrics

Develop, implement and evaluate unit quality management goals and attainment of objectives.

Participate and lead inter-departmental committees/teams to develop proactive management solutions and implement proactive care management programs.

Interact with all levels of management and units, both internal and external, to ensure that Blue Health Coach programs meet provider and patient care needs, and are consistent with provider contracts.

Strives to meet or exceed savings goals for programs

Constructs workflows, provide feedback as to appropriate production standards and contribute toward policies and procedures in accordance with medical policy and claims payment guidelines.

In conjunction, with associates, develops individual performance plans and provide ongoing reviews for all team members.

Works closely with the Regional Medical Directors, Providers Relations, Network Development, Contracting, etc. to ensure that programs meet provider and patient care needs, and are consistent with provider contracts.

Qualifications:

Excellent organizational, problem solving and communication skills.

Proven management, business management and negotiation skills.

Proven customer service skills.

Proven presentation abilities

Working knowledge of health care laws and regulations.


5 plus years experience managing in a managed care environment.

3-5 years experience in a clinical area

Registered Nurse with an active professional Massachusetts license

Knowledge and understanding of chronic conditions required, i.e., cardiovascular disease, diabetes, COPD.

Advanced degree in business and/or nursing preferred.