Base 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.”

The Population Health Integration Consultant is responsible for assisting with integration of population health programs and processes within our clinical systems/applications. This position is able to work with management and incorporate the strategic vision into operational clinical processes to support population analysis and program evaluation of our clinical programs to ensure cost containment effectiveness for our employer groups and health and wellbeing of our membership. The role will support clinical project management activities and implementation lifecycle for clinical initiatives including but not limited to: project planning, documentation requirements, testing and system upgrades. Additional responsibility regarding technical assistance, specialized training, and reviewing clinical processes and leading opportunities for improvement. This position may also help with the development of virtual program offerings and creation of those offerings on a Learning Management System.

• Assist with the technical/clinical support and implementation for TruCare functionality for Capital’s population health efforts - may include, but not limited to, system upgrades, developing use cases and requirement development for new functionality/processes, and testing.
• Assist with the technical/clinical support and implementation of new and/or legacy processes that may reside outside of TruCare. Provide recommendations to support integration.
• Support clinical project management activities being the SME between strategy and Capital’s technical applications. Develop implementation strategies to support project timeline and deliverables, resolve problems and recommend remediation.
• Able to monitor progress and garner cross-functional support to implement. SME for technical aspects of our clinical systems to support PHM standards/requirements/regulations.
• Support integration of Capital’s various internal and external clinical programs and vendors (e.g. HPW, Behavioral Health, Retail, Care Management, and external vendors) into Capital’s medical management platform (TruCare). Work collaboratively with PHM team and cross functionally on the clinical vendor data integration to support improved holistic PHM system capture, analysis and evaluation. This work will support futuristic integration with Member Services - Salesforce module - to provide comprehensive view of the clinical programs supporting the member.
• Supports the technical development of educational courses delivered to a wide variety of customers.

Skills:

• Strong decision making and problem-solving skills (verbal and written). Ability to analyze complex problems and issues, determine impact, and develop business solutions or recommendations for changes. Ability to communicate ideas and issues effectively, both verbally and in writing, across all departments. Demonstrated skills in a variety of electronic communication applications, including but not limited to, Word, Excel, and PowerPoint. Strong relationship building skills

Knowledge:

• Knowledge of current and emerging educational tools and practices. Knowledge of NCQA, JCAHO and American Accreditation Healthcare Commission/URAC standards. Knowledgeable with managed care (e.g. HMO, POS, PPO) products and operations and impact to employer/member/provider engagement efforts. Comprehensive knowledge of project life cycle and process improvement methods.

Experience:

• Minimum of 2+ years’ experience in managed care, including medical management or equivalent healthcare experience. Experience with project management methodologies, software implementation, and general health plan medical management integration. Minimum of two years’ experience in developing and delivering educational programs, preferably in a health-related business.

Education and Certifications:

• A Bachelor’s Degree in Computer Science, Business, Health Care Administration or a related field or relevant experience equivalent to meet education requirement.

Work Environment:

• Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor. Working environment includes typical office conditions.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

We 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.