Description of the situation

Base salary is affected by several factors including the candidate’s qualifications, relevant experience, and expected contributions to meet business needs, along with internal pay equity and external market-driven rates. The salary range displayed is not adjusted by geographic location. This range has been established in good faith based on information known to Capital Blue Cross at the time of publication and may be modified in the future. Capital Blue Cross offers a comprehensive benefits package including medical, dental and vision coverage, retirement plan, generous time off including paid vacation and holidays, volunteer time off, 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, which is why our employees are consistently voted one of the “Best Places to Work in Pennsylvania.”

The Senior Director of Population Health Strategy and Operations is a data-driven leader responsible for designing, implementing and aligning population health clinical programs across the capital enterprise. The Senior Director is responsible for executing strategy across the health and wellness functions, driving operational excellence and clinical innovation across ASO’s employer groups and fully insured risk groups. This position is responsible for P&L including the diverse clinical operations team and contract vendor solutions group.

Responsibilities and qualifications

• Strategic Leadership and Innovation: Lead the development and implementation of organization-wide population health strategies that drive organ quality and cost outcomes. Design, build and translate data insights into strategic initiatives and operational plans that support the organization’s long-term goals. Serve as a thought partner to senior leadership, helping to shape the future of population health through innovation and cross-functional collaboration.
• Operational Excellence: Responsible for P&L financials including vendor spend and ROI. Leads clinical relationships with vendors/partners and oversight functions. Responsible for vendor performance and driving contractual relationships with new and existing vendors/partners. He leads the population health team, working collaboratively with care management, sales and marketing, to drive value-added clinical programs through Capital’s ASO employer business. Drives the culture and practice of continuous process improvement, especially for business functions that involve multiple internal and external stakeholders. Strategically develops and adjusts program effectiveness measurement to support internal and external customer reporting and performance management strategies.
• Data-driven culture and infrastructure: Support data literacy across the population health team, and train and upskill staff to better leverage analytics in decision-making. Collaborate closely with IT, Informatics and Analytics teams to ensure strategic alignment, visibility and dependency management across clinical documentation and data platforms.
• Cross-Functional Team Collaboration: Lead cross-functional work groups to operationalize new models of care with a priority focus on driving MLR improvements to the Medicare Advantage segment. Serve as a liaison between strategy and execution, ensuring operational and technical teams are aligned with organizational priorities and dependencies are identified, coordinated and managed

skills:

• Must be able to think strategically and lead/motivate individuals within the department to drive organizational strategies in the context of rapid change.
• Unwavering commitment to quality programs and data-driven leadership.
• Powerful people influence the ability to engage a wide range of stakeholders in change.
• Ability to identify root causes of complex and systemic problems and formulate lasting solutions.
• Excellent strategic and management skills, including the ability to interact successfully with management and employees at all levels of the organization – including senior officials.
• Ability to multi-task and handle competing priorities without compromising quality.

knowledge:

• Health care delivery strategy, program management and management concepts.
• Experience in modern productivity management and team leadership practices.
• Project management, process improvement, quality improvement or organizational design.
• Population management programmes, objectives, strategies, results and experience in the successful implementation of these programmes.
• Managed care offerings (commercial HMO, PPO, POS, EPO, Medicare, and Medicaid (CHIP)) and how to interpret, deliver, and manage benefits.

expertise:

• – A minimum of seven years of progressive healthcare leadership experience including new clinical program development and five years of management experience.

Education and certificates:

• Master’s degree in related field.
• You may be responsible for caring for, supervising, directing or controlling children or having routine interactions with children. Therefore, according to the Pennsylvania Child Protective Services Act, you must submit to and obtain clearances through comprehensive and regularly updated criminal background checks.

Work environment:

• Hours vary by department and customer needs. Work primarily remotely from home with expected travel to the office or client location for meetings as needed.

Physical requirements:

• While performing job duties, the employee is frequently required to sit, use hands and fingers, speak, hear, and see. The employee must be able to work more than 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work that involves long periods of sitting, talking, active listening, writing, and performing repetitive movements. The work requires the ability to carefully examine written documents, computer generated documents as well as the computer screen.

location:

• This position is classified as hybrid and requires on-site work on Tuesdays and Wednesdays.

about us

We recognize that work is part of life, not separate from it, and we foster a flexible environment where your health and well-being are prioritised. At Capital, you will work alongside a caring team of supportive colleagues, and will be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so that you have the tools to do your best as you develop your career.
By doing your best, you will help us achieve our mission of improving the health and well-being of our members and the communities in which they live.

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Capital Blue Cross is an independent charter company 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, sex, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, marital status, or any other status protected by applicable law.