Director, Population Health Applications

Position DescriptionBase pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”This role is responsible for the strategic and operational management of Capital Blue Cross’s portfolio of clinical technology solutions and the business processes they enable. The Director is responsible specifically for Care Management, Clinical Vendor and Utilization Management software applications and their related technology ecosystems. This role ensures alignment through workflow design and solutions co-development with cross functional teams. The role functions to triage, coordinate and operationalize product needs and enhancements in tight coordination with strategic leadership, operations and technical subject matter experts. The Director represents population health on data governance committees while also partnering with analytics teams to co-engineer insights that depend on underlying data & business logic.Responsibilities And QualificationsAccountable for the daily operations of Capital’s suite of care management, utilization management and vendor solutions. This includes coordinating system upgrades, engineering new use cases or workflows, liaising with vendors, clearly documenting requirements and testing changes before production.Design and develop the business strategy and requirements needed to monitor and dynamically manage member clinical interventions across multiple current and future use cases. Accountable for engineering systems that can trigger the right clinical interventions for the right member at the right time.Partners with operations leaders to plan for and incorporate AI/ ML and automation solutions where appropriate and updates strategy as vendor capabilities evolve.Works with enterprise leadership to ensure that requests are appropriately prioritized and cross-functional dependencies are identified and managed.Responsible for coordinating resources and aligning on product changes by maintaining an intake, triage and strategic roadmap project queue. Regularly reports on project status, risks and resource capacity to inform dynamic adjustments to project priority and timeline. Maintains project portfolio status and visibility across all impacted stakeholders.Partners with analytics colleagues to ensure that data emanating from population health applications is appropriately governed, and that clinical workflows are generating the expected discrete data to support analytics and reporting.Partners with operations management to develop reports and embed insights that aid productivity management and improve the efficiency of clinical workflows.Supports the bi-directional movement of files to and from vendors to support effective member engagement, minimize administrative waste, and maximize outcomes across Quality, Risk and Total Cost of Care.Responsible for evaluating the impact of regulatory changes on technology solutions and workflows, including risk mitigation and compliance with CMS, NCQA, FEP, BCBSA or other regulatory body mandates.Develops and calibrates agile workflows to manage team productivity and maintain high quality user experience for the clinical team members.SkillsFunctional experience and comfort leading with contemporary Product Management practices (Agile, Kano, Lean etc.).Strong decision making, problem solving, and presentation skills (verbal & written)Ability to analyze complex problems and issues, determine impact, and develop business solutions or recommendations for changes.Ability to communicate complex issues effectively and across a range of stakeholder skillsets to foster cross-functional relationships and tactical alignment.Must be comfortable with change and possess the ability to lead and motivate individuals to execute in the face of rapidly evolving requirements without losing sight of strategic goals.KnowledgeWorking knowledge of contemporary healthcare clinical operations workflows.Working knowledge of Health Plan priorities including HEDIS and Risk coding.Knowledge of contemporary and evolving healthcare technology capabilities including a propensity to learn and apply AI/ ML/ automation solutions to solve business problems.ExperienceMinimum of 6 years in a formal Product Management role and/ or leadership at the intersection of healthcare operations and health technology management.Minimum of 3 years of supervisory experience.Education And CertificationsMaster’s degree in a related field is required.Physical DemandsWhile performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.Location:Hybrid preferred: onsite work Tuesdays and Wednesdays in Harrisburg, PA.About UsWe recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity 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.