Resp & Qualifications
The Wellness and Disease Management Program Manager is responsible for the design, implementation, operations, communication and evaluation of a range of wellness programs that serve our commercial markets and applicable government programs. Serves as the primary liaison with our external vendor partner(s) and manages the contractual relationship and all day-to-day activities. Leads the design and build of an analytic infrastructure to manage vendor partner performance, evaluate the impact of the Wellness and Disease Management Program, and communicates a compelling value story to members and accounts. Collaborates daily with Wellness Consultants and additional internal stakeholders as needed on all program elements, including Marketing, Commercial Markets, Government Programs, Corporate Development, and the Division’s internal Care Support and Health Economics teams. Ensures alignment with the overall corporate vision and goals by focusing on compliance, procedures and monitoring/control to achieve program goals. Manages a small team of project managers to support the wellness and disease management program.
ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to, the following:
Duties and Responsibilities
Responsible for the design, implementation, and operations the Wellness and Disease Management Program, ensuring smooth operations between CareFirst and the vendor partner(s). Serves as primary operational liaison with vendor partner(s); manages the contractual relationship including pricing, performance, contract terms, service level agreements and other key elements.
• Oversees the process of contracting, rate negotiations with vendor partner(s).
• Oversees all go-live activities to ensure that all parties are supported and assisted.
o Ensures efficient and high-quality installation of new programs and services and monitors all aspects of implementing projects.
o Lead for tracking, analyzing and ensuring resolution of system and/or process-based issues in the initial go-live phase.
• Trouble shoots barriers that limit program impacts, including day-to-day and systemic issues. Ensures that vendor partner(s) provides services in accordance with services level agreements.
o Addresses escalated service issues, including onsite face to face meetings with executives to ensure the vendor partner(s) resolves ongoing issues in acceptable long-term solutions.
o Conducts regular meetings with vendor partner(s) to manage issue escalation, new program development and enhancements.
• Oversees Monthly Wellness and Disease Management Program Vendor(s) Invoice Process
o Coordinate monthly invoices, this includes auditing, approving, recording and payment of all the invoices for services that are paid thru CARE. Submit each individual invoice thru Oracle for payment. Forward all paid invoices to Finance for entry into General Ledger. Track and enter all invoice payments into the Master Wellness Account spreadsheet. Act as liaison between vendors and Accounts Payable to verify payments or location of missing payments & checks.
o Tracks and reports on the financial aspects of the Program.
o Performs Annual Medical Loss Ratio reporting
o Monitors claims payment activities and works with the appropriate business leaders across the organization to ensure resolution of escalated claims issues.
o Works with vendor partner(s) and internal business units to ensure program claims are accurately submitted and processed.
• Oversees and evaluates the Wellness and Disease Management Program, policies and procedures to ensure compliance with all Federal/State/DC regulations and external accreditation standards pertaining to or affecting health care systems.
o Maintains full quality accreditation through NCQA with submission of all necessary documentation.
o Ensures compliance to current FEP PPO Guidelines for Disease Management Program and provide update to their annual Business Plan.
o Actively participates in account-specific audits.
Lead the design and implementation of an analytic infrastructure to manage vendor partner performance, evaluate the impact of the Wellness and Disease Management program, and communicates a compelling value story to members and accounts.
• Leads the design and implementation of reporting on the program’s operational and engagement metrics, clinical outcomes and cost of care for members and accounts, in collaboration with the Health Economics team.
• Evaluates and interprets complex program data to identify gaps in performance and identify opportunities for program optimization.
• Ensures that reporting supports management of vendor partner performance, including adherence to program guidelines, service level agreement, performance guarantees and/or other contractual obligations.
• Leads the preparation of quarterly performance summaries.
Performs the high-level tasks associated with general Program Management. Collaborates daily with Wellness Consultants and other internal stakeholders from Marketing, Commercial Markets, Government Programs, Corporate Development, and the Division’s internal Care Support and Health Economics teams for the purpose of managing the Wellness and Disease Management Program.
• Oversees the interdependencies between various complex work streams and works to ensure the Program meets its goals and objective. Evaluates complex situations accurately and identifies viable solutions that create successful outcomes for the Program.
• Manages all aspects of Program, which may include conducting cost benefit analysis, developing work plans, monitoring of vendor service level agreements, designing policies and procedures, developing workflows, and implementing business and system monitors and controls.
• Provides both verbal and written communications regarding Program status, risks, issues, and risk mitigation plans. Makes recommendations on program decisions to leadership.
• Develops and maintains “lessons-learned” inputs for utilization on future projects.
• Coordinates the resolution of resource, budgeting, change, and legal issues affecting the Program.
• Establishes performance criteria, assesses performance, addresses performance issues, and provides training and development.
• Manages allocation of resources and out of office schedules to meet work fluctuations and time deadlines in the delivery process.
• Coaches to clarify assignments and deliverables; mentors team in project management practices; reviews quality of work and proactively manages the mixture and add-ons of team members’ work to mitigate risks.
• Bachelor’s degree in a health, wellness, or business-related field; in lieu of Bachelor’s degree must have 4 years related work experience.
• 5-7 years of project or program management and/or consulting experience in a health, wellness, or related environment.
• Proven ability to coach and mentor less seasoned team members, providing day to day oversight and direction.
• Knowledge of best practices in workplace wellness, creating a workplace culture of health, health behavior and health education, population health, disease prevention, and/or disease management.
• Ability to hold vendor partner(s) accountable to drive program performance.
• Experience with digital healthcare platforms or tools.
• Ability to lead dynamic, multidisciplinary high-performance work teams to find creative solutions that optimize program goals and performance.
• Expert ability to synthesize complex data and analysis into clear, concise communications. Experience in developing and delivering executive level presentations and reports on strategic initiatives.
• Strong interpersonal skills, with the ability to communicate and effectively influence associates and management across divisions and at all levels of the organization.
• Excellent oral and written communications; an ability to present and discuss analytical and technical information in a way that establishes rapport, persuades others, and gains understanding.
• Strong management, business planning, and organizational skills.
• Demonstrated proficiency with multiple reporting applications and tools, including MS Excel, Access, Word, PPT and Project.
• Experience with vendor management, including development of RFPs and SOWs and the tracking and monitoring of service level agreements.
• Knowledge of the health insurance industry and current and emerging health and wellness trends.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Master’s degree in Healthcare, Business or Technology related field.
• Prior health insurance industry experience.
• Project Management certificate (PMP) from the Project Management Institute (PMI).
• Thorough knowledge and understanding of the company’s business practices and direction, busi¬ness principles, and business processes, plus familiarity with the company’s products and resources.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please apply before: 1/25/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship