• Job Description

  Req#: R-46481

  Job Responsibilities:

  • Lead and support the implementation of affordability initiatives across all lines of business.
  • Influence outcomes across a matrixed organization to deliver affordability targets in the following categories: payment policy, payment integrity, clinical operations, pharmacy, network, and medical cost vendors.
  • Partner with the total health management team to set agendas and coordinate the commercial operational finance meetings with a focus on actionable initiatives leading to a reduction in medical trend.
  • Provide detailed reporting to senior leadership on the progress and value of affordability initiatives against identified targets.
  • Understand and integrate clinical operations to drive affordability strategies effectively.
  • Monitor and analyze the impact of affordability initiatives on clinical outcomes and financial performance.
  • Identify opportunities for cost savings and efficiency improvements within clinical operations.
  • Lead a team of clinical and finance associates to execute on the affordability initiatives.
  • Mentor and train associates to better understand nuances specific to LOBs/products and project management necessary for implementation of initiatives.

  Job Qualifications:

  Education

  • Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

  Experience

  • 7 years experience in Healthcare Clinical Operations, preferably in the health insurance industry.
  • 3 years of leadership/managerial experience required

  Skills/Certifications

  • Familiarity with healthcare affordability initiatives and best practices
  • Proven ability to drive medical cost savings initiatives
  • Strong strategic planning, analytical, innovative and decision-making skills
  • Familiarity with multiple managed care lines of business (eg, Commercial, Medicare Advantage, Medicaid) and product types is preferred

  Number of Openings Available:

  1

  Worker Type:

  Employee

  Company:

  BCBST BlueCross BlueShield of Tennessee, Inc.

  Applying for this job indicates your acknowledgement and understanding of the following statements:

  BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

  Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

  BCBST's EEO Policies/Notices

  BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

  Tobacco-Free Hiring Statement

  To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

  Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

• About the company

  BlueCross BlueShield of Tennessee is the largest health benefit plan company in Tennessee.

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