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 Director is responsible for the strategic and operational management of Capital Blue Cross’s portfolio of clinical solutions and the business processes they enable.  The role leads business requirements, clinical workflow design, prioritization, and operational enablement for an ecosystem of Care Management, Clinical Vendor, and Utilization Management applications, and partners with IT&D for technical architecture, system engineering, integrations, data movement, SDLC processes, and production changes.

The Director ensures alignment across clinical and operational teams through thoughtful workflow design, cross‑functional solution co‑development, and a structured process for triaging, coordinating, and operationalizing product needs and enhancements.  The role maintains visibility into product priorities, dependencies, and progress through effective intake and roadmap practices.

The Director represents Population Health in data governance forums and partners with analytics teams to ensure that workflows and applications generate high‑quality, discrete data needed for reporting, insights, and clinical decision support

• Accountable for the daily clinical operations of Capital’s suite of care management, utilization management and vendor solutions. This includes partnering with technical leadership to coordinate system upgrades, design new use cases or workflows, liaise with vendors, document requirements and test changes before production.
• Design and develop the business strategy and requirements needed to monitor and dynamically manage member clinical interventions across multiple current and future use cases. Accountable for designing technology-enabled workflows and systems that can trigger the right clinical interventions for the right member at the right time.
• Partners with operations leaders to plan for and incorporate AI/ ML and automation solutions where appropriate and updates strategy as vendor capabilities evolve.
• Works with enterprise leadership to ensure that requests are appropriately prioritized and cross-functional dependencies are identified and managed.
• Responsible for coordinating resources and aligning on product changes by maintaining an intake, triage and strategic roadmap project queue. Regularly reports on project status, risks and resource capacity to inform dynamic adjustments to project priority and timeline. Maintains project portfolio status and visibility across all impacted stakeholders.
• Partners with analytics colleagues to ensure that data emanating from population health applications is appropriately governed, and that clinical workflows are generating the expected discrete data to support analytics and reporting.
• Partners with operations management to develop reports and embed insights that aid productivity management and improve the efficiency of clinical workflows.
• Supports the bi-directional movement of clinical information to enable effective member engagement, minimize administrative waste, and maximize outcomes across Quality, Risk and Total Cost of Care.
• Responsible for evaluating the impact of regulatory changes on technology solutions and workflows, including risk mitigation and compliance with CMS, NCQA, FEP, BCBSA or other regulatory body mandates.
• Develops and calibrates agile workflows to manage team productivity and maintain high quality user experience for the clinical team members.

Skills:

• Functional experience and comfort leading with contemporary Product Management practices (Agile, Kano, Lean etc.).
• Strong decision making, problem solving, and presentation skills (verbal & written)
• Ability to analyze complex problems and issues, determine impact, and develop business solutions or recommendations for changes.
• Ability to communicate complex issues effectively and across a range of stakeholder skillsets to foster cross-functional relationships and tactical alignment.
• Must be comfortable with change and possess the ability to lead and motivate individuals to execute in the face of rapidly evolving requirements without losing sight of strategic goals.

Knowledge:

• Working knowledge of contemporary healthcare clinical operations workflows.
• Working knowledge of Health Plan priorities including HEDIS and Risk coding.
• Knowledge of contemporary and evolving healthcare technology capabilities including a propensity to learn and apply AI/ ML/ automation solutions to solve business problems.

Experience:

• Minimum of 6 years in a formal Product Management role and/ or leadership at the intersection of healthcare operations and health technology management.
• Minimum of 3 years of supervisory experience.

Education and Certifications:

• Master’s degree in a related field is required.

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 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.