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 Senior Director, Population Health Strategy & Operations is a data-driven leader responsible for designing, executing, and harmonizing population health clinical programs across the Capital enterprise. The Senior Director is accountable for strategy execution across health and wellness functions, driving operational excellence and clinical innovation through both ASO employer groups and fully insured risk populations. This position is responsible for a P&L inclusive of a diverse clinical operations team, and portfolio of contracted vendor solutions.

• Strategic Leadership & Innovation: Lead the development and execution of enterprise-wide population health strategies that drive member 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 shape the future of population health through innovation and cross-functional collaboration.
• Operational Excellence: Accountable for P&L financials inclusive of vendor spend & ROI. Leads clinical vendor/partner relationships and oversight functions. Accountable for vendor performance, leading contract relations with new & existing vendors/partners. Leads Population Health team, working collectively with Care Management, Sales and Marketing, to drive value- added clinical programs though Capital’s ASO employer business. Leads a culture and practice of continuous process improvement, especially for business functions that span 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 & Infrastructure: Champion data literacy across the Population Health team, coaching and upskilling 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 workgroups to operationalize new models of care with a priority focus on driving MLR improvements to the Medicare Advantage segment. Act as a connector between strategy and execution, ensuring that operational and technical teams are aligned with organizational priorities and that dependencies are identified, coordinated and managed

Skills:

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

Knowledge:

• Healthcare delivery strategy, program management and administration concepts.
• Experience with modern productivity management and team leadership practices.
• Project management, process improvement, quality improvement, or organizational design.
• Population management programs, goals, strategies, outcomes and experience with the successful implementation of these programs.
• Managed care offerings (Commercial HMO, PPO, POS, EPO and Medicare and Medicaid (CHIP) and how benefits are interpreted delivered and managed.

Experience:

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

Education and Certifications:

• Master’s degree in related field.
• You may be responsible for the care, supervision, guidance, or control of children or otherwise have routine interactions with children. Therefore, in accordance with Pennsylvania’s Child Protective Services Law, you must undergo and obtain clearances through comprehensive and regularly updated criminal background checks.

Work Environment:

• Hours vary depending on department and customer needs. Primarily remote work from home with expected travel to office or customers location for meetings as needed.

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. Sedentary work involving significant periods of sitting, talking, active listening, typing and performing repetitive motions. Work requires ability to perform close inspection of written and computer-generated documents as well as a PC monitor.

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.

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.