• Job Description

  Req#: 1859

  Clinical Program Effectiveness Specialist

  Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America Req #1859

  Saturday, January 27, 2024

  Please email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

  Schedule: Hybrid
  Compensation: $71,700 - $107,700

  Jump into the new world of health insurance:

  At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.
  

  Join others who know diversity is strength:

  We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.
  

  Why this job matters:

  Develop evidence-based, best practice clinical pathways and associated resources in support of clinical initiatives, including care management, utilization management, MET, pharmacy, and quality programs. Collaborate and lead internal and external stakeholders on the development of these population health programs. Implement programs across settings, including within BCBSRI, the provider community, and employers. Construct toolkits in support of implementation. Utilize behavioral economics and positive psychology to support the adoption of best practices. Create process and outcome measures of success for programmatic evaluation.

  What you will do:

  • Develop evidence-based, clinical best practice clinical pathways in diverse areas including, but not limited to, musculoskeletal care, cardiology, oncology, obesity, chronic kidney disease, and diabetes. This includes the development of white papers, algorithms, flowcharts, checklists, educational booklets, digital content and presentations in support of this work. Conduct reviews of medical literature and synthesize these reviews into the background materials necessary to construct clinical pathways materials. Guide teams through this information with thoughtful prepared materials.
  • Lead the collaboration of internal and external stakeholders to build the essential programmatic elements utilizing best practices in performance improvement and project management. These stakeholders may include physicians, nurses, registered dieticians, social workers, and operational team members. External stakeholders may include health systems, ACOs, employers, and vendors.
  • Educate and empower stakeholders on clinical pathways to maximize adoption. Engage stakeholders throughout the process. Utilize behavioral economics and positive psychology to inspire and create meaningful change.
  • Lead the development and implementation of measures of success to evaluate program effectiveness. Work cross-functionally with analytics and IT teams to create dashboards and data reports looking at process and outcome measures. Interpret both qualitative and quantitative data to identify areas of opportunity and implement changes. Support stakeholders in the utilization of data.
  • Utilize performance improvement and project management skills (or best practices) to address a business need or opportunity for improvement. This includes, but is not limited to, the ability to construct project charters, A3s, root cause analysis, FMEA, RACI, etc.
  • Proactively manage cross-organizational accountabilities on assigned projects.
  • Perform other duties as assigned.

  What you need to succeed:

  • Bachelor’s degree in Nursing or related field, or an equivalent combination of education and experience with current, valid licensure as a health professional
  • Five to seven years of experience in utilization review, case management, quality, risk and/or disease management and up to five years clinical nursing or other related applicable experience
  • Career experience in building clinically related content and educational materials Establish and maintain strong working relationships with various stakeholders including team members, IT resources, resources in other areas of the business and upper management
  • Ability to read and synthesize information from medical literature
  • Strong medical writing skills
  • Ability to create appropriate content for a variety of audiences including health plan members and providers

  • Strong business acumen and political savvy
  • Strong critical-thinking and problem-solving skills

  • Ability to lead and manage projects
  • Ability to collaborate while dealing with complex situations
  • Ability to think creatively and to drive innovation
  • Ability to motivate, lead and inspire a diverse group to a common goal/solution with multiple stakeholders
  • Ability to convert business strategy into action-oriented objectives and measurable results
  • Strong negotiating, influencing, and consensus-building skills
  • Ability to mentor, coach and provide guidance to others
  • Proactively identifies problems and addresses issues
  • Strong presentation skills, including experience creating PowerPoint presentations and delivering to large groups
  • Strong analytical skills, including the ability to create Excel-based reports
  • Strong skills in creating algorithms with tools like Microsoft Visio
  • Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner

  Extras :

  • Case Management Certification (CCM)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Experience leading workshops and meetings comprised of managers and leaders from different departments
  • Experience in performance improvement methodology and/or project management
  • Experience in technical writing in medicine

  Location:

  BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

  • In-office: onsite 5 days per week
  • Hybrid: onsite 2-4 days per week
  • Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

  :

  At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
  The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

  Other details

  • Pay Type Salary

  Apply Now

• About the company

  Rhode Island's leading health insurer and an independent licensee of the Blue Cross and Blue Shield Association

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