Business Consultant-Government Programs

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas. Visits to the office for meetings approximately 1 time per month or as needed.

This role is responsible for leading the development and execution of the organizationâ??s strategic efforts and business processes for government programs including Medicare (MA and PDP), Medicaid, ACA, and other health care services which may be funded by the State or Federal Governments. This role will be accountable to ensure all business processes comply with all regulations while ensuring strategic goals are achieved while maintaining exception customer experience. The role will lead strategy and innovative business process development that aligns with enterprise winning aspirations. The role will also lead, develop, and monitor strategic capabilities in how we manage and use product data. This role develops, implements, and optimizes business processes that are grounded in regulatory compliance, analytics, and financial profitability.

What you'll do:

• Lead the development of strategic business processes with business leads across the organization including provider contracting, operations, medical management, finance, sales, and compliance for Medicare Advantage Medicaid, ACA, and other government funded programs.
• Jointly develops and supports execution of provider contracting and reimbursement strategies for the Medicare Advantage network(s) across the State.
• Ensure all business processes comply with CMS, DOI, and other regulatory requirements by consulting with legal and compliance in the development and execution of policies and procedures.
• Lead in an ethical manner through modeling BCBSNEâ??s core values and code of conduct principles. Ensure all employees are demonstrating BCBSNEâ??s core values and code of conduct principles as well as taking appropriate steps when unethical actions are reported or observed.
• Support the growth and development of membership in Medicare and Medicaid by collaborating in the development of â??bidsâ? for these programs on an annual basis. Co-leads the RFP response for government bids with the appropriate Market Segment leader.
• Partner as an effective member of the BCBSNE leadership team by demonstrating behaviors that align with Blue Cross Blue Shield core leadership principles, behaviors, and values.
• Develop strategic plan to advance the company mission and objectives to promote revenue, profitability, and growth for all government funded programs.
• Responsible for monitoring and analyzing all regulatory changes to develop business processes which ensure compliance and strategic objectives can be met.
• Provide consultive direction to Marlet Segment Leader(s), ELT, and SLT and work closely with product, network, insights, marketing, sales, legal, compliance, finance, actuarial, enrollment, ESS, IS, medical management, and pharmacy to build and present a solid product to market.
• Provide guidance and support to Chief Medical Officer to understand clinical needs to manage individual population health programs and achieve CAHPS, HEDIS, URAC and other program measures.
• Provide cross functional insights to all BCBSBNE leaders of teams working to execute Medicare Advantage market strategy.
• Communicate with senior leadership on current and future state of initiatives that align with the organization's vision.

To be considered for this position, you must have:

• Bachelorâ??s degree and five (5) yearsâ?? experience working with government-funded health insurance, such as Medicare Advantage and/or Medicaid
• 5+ years' experience with government programs claims experience
• 5+ years of leadership in Medicare Advantage operations oversight
• Experience with Medicare Advantage operations compliance

An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The strongest candidates for this position will also possess:

• In depth operational experience within government programs

• Understand competitorâ??s strengths, weaknesses, and strategies. Provide competitive feedback and market perspectives to internal teams responsible for managing products

• Keep current with changes, proposed or threatened, of Federal and State laws, regulations, contracts and rulings related to the health care industry

• Understanding impact to consumers and BCBSNE

• Understand the health care industry, market dynamics, and trends for all health care products impacting the Individual market

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.