Capital BlueCross
Senior Population Health Consultant (Finance)
The individual will lead key population health assessment projects using available analytical tools including Theon, consult with customers on population health strategy development, and facilitate targeted interventions across the care delivery team to quantitatively improve consumer health outcomes.
The Consultant works with their assigned customer base in leveraging all available analytical tools, including Theon, to identify opportunities for clinical intervention, recommend strategies to address the identified opportunities and assist in the identification of optimal clinical support and programming.
The Consultant will serve as a liaison between the patient/participant and the clinical teams available to support their needs. Additionally, the individual will lead initiatives focused on quality strategy, population health and medical value analysis, and provide data-driven reporting, while maintaining compliance with accreditation and regulatory requirements. The individual will research and employ nationally recognized quality standards and metrics; analyze quality outcomes; assist with development of data collection tools/scoring methodology; and participate in accreditation activities.
The individual will also be a subject matter expert in the design and implementation of CBC products, services and capabilities.
Leadership:
Two years of advancing experience in a leadership role in the health care industry preferred
Skills:
Ability to operate personal computer and proficiency in Microsoft word/excel/access applications.
Ability to conduct research using the internet as directed by management.
Ability to communicate professionally, clearly and effectively, through written/electronic means as well as oral communications with internal and external audiences.
Demonstrated ability to develop rapport effectively and maintain strong interpersonal relationships internally and externally.
Ability to prioritize workload and assignments and perform accurate detailed and timely completion of assigned duties.
Knowledge:
Knowledge of managed care products and processes, preferred.
Knowledge of motivational interviewing and intrinsic coaching, preferred.
Experience:
5 years of clinical experience
Prior analytic experience and proficiency with analytic tools and/or provider EHR's preferred.
Education, Certification, and Licenses:
Registered Nurse with active Pennsylvania License. Licensure must be in good standing.
Certification as CCM or CCP is preferred.
Bachelor's Degree in health care is strongly preferred
Master's Degree in business or health care related field a strong plus
Possession of valid Driver's License and ability to travel to customer locations.
Work Environment:
Part time work from home available at management discretion after probationary period with a requirement for coming into the office and to customer locations as deemed necessary by management.
Travel Requirements:
Interstate travel required based on customer needs which may include but is not limited to a weekly basis.
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.