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.”

Serves as a primary interface between clinical services and other departments to ensure multi- and inter-disciplinary vendor project coordination. Participates in communication and project planning regarding other company/department initiatives. Collaborates with clinical department directors and other key staff in overall project evaluation, Identifies key benchmarks for use in evaluation. Initiates and directs planning related to project development including identification of project objectives, expected outcomes, resource requirements and evaluation strategies. Professional who is trained to properly present data that supports clinical and business decisions. Assists clinical department directors and other in the interpretation and use of data for decision-making. Applies clinical knowledge and use of healthcare data to drive decisions. Present information to help organization leaders understand clinical impact of data to drive healthcare quality improvement. Improves and innovates the use of technology within clinical practice and workflows.

• Assists leadership to decide whether to add or replace a new service line to support member initiatives.
• Oversight of external and internal sourced data management to include vendor reports.
• Collaborate with internal vendor management to perform oversight of external vendor contracts as it relates to performance guarantees and service level agreements.
• Interpretation of vendor reports to guide department/organization for clinical opportunities to impact lower cost of care, improve quality of care, and enhance member experience and member engagement.
• Responsible for managing the relationships with specific vendors and serving as the organizations point of contact.
• Analyzes and evaluates vendor proposals and assists in vendor selection.
• Provides support to the organization for problems with vendor products and services.

Skills:

• Demonstrated excellent public speaking and written communication skills.
• Experience leading a project resulting in positive change management

Knowledge:

• Project management
• Knowledge of NCQA, JCAHO and American Accreditation HealthCare Commission/URAC standards.

Experience:

• 5 years progressive clinical experience and/or informatics-related experience.
• 2 years experience in the health insurance, or other related healthcare field.
• 3 years of clinical and/or informatics-related experience

Education and Certifications:

• Bachelor’s degree in business, education or a health-related field or 9 years of relevant experience in lieu of degree.
• RN licensure preferred.

Work Environment:

• Ability to work independently as well as collaboratively within a small team to meet quality and timeframe requirements is required. Ability to handle multiple assignments with changing priorities is a ‘must’.

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.