Location: Hybrid
Compensation: $51,300 - $77,000

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:

Assist in the overall implementation and daily operations of behavioral health (BH), quality, and delivery systems transformation initiatives internally as well as in the community. Track program implementation, metrics, opportunities, and overall visibility of behavioral health initiatives. Contract with behavioral health facilities to ensure a quality focused, high-performing behavioral health network and to ensure network adequacy for BCBSRI members.

What you will do:

• Assist in overall management of behavioral health programs that align with an integrated cost-effective delivery model to improve member quality of life.

• Serve as primary behavioral health facility contracting liaison. Maintain contracts with BH facilities to ensure a quality-focused, high performing BH network.

• Manage operational aspects of BH programs. Provide support to internal areas to resolve BH provider claims/payment inquiries. Collaborate with key areas to ensure appropriate system configuration to support BH programs. Collaborate with key areas to resolve BH provider issues. Triage and track operational issues; mobilize stakeholders for effective problem resolution. Attend applicable committees.

• Assist in BH program development and implementation. Identify key stakeholders, develop business requirements and business case, facilitate execution of business requirements, monitor report and analyze program process and outcome metrics.

• Assist with the development and implementation of a provider communication strategy. Collaborate with identified areas to develop and maintain a behavioral health provider web page.

• Prepare documentation, data, and reports for management and quality oversight committees as needed.

• Participate in department projects and initiatives.

• Perform other duties as assigned.

What you need to succeed:

• A combination of education and related experience
• One to three years of experience in behavioral health clinical quality activities or applicable experience in the health insurance industry
• Knowledge of clinical quality management principles or business process improvement techniques
• Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, and disease management and case management program development
• Knowledge of regulatory and accrediting standards including, but not limited to NCQA, URAC, DOH, DHS, CMS
• Facilitation skills
• Strategic and critical thinking skills
• Strong analytical skills
• Strong business acumen and political savvy
• Strong negotiation skills
• Strong written and verbal communication skills
• Strong problem solving skills
• Ability to work effectively with a wide variety of people in individual and group settings
• Strong organizing skills, with the ability to prioritize and respond to shifting deadlines
• Strong time management skills
• Ability to manage diverse and deadline-oriented workflow
• Ability to work in a fast paced dynamic work environment.

Extras

• Experience with contract development and negotiation
• Project management skills
• Experience in program development, including staff training

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

• Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America