Rn Manager, Clinical Transformation & Quality Specialty Value Based Care

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
In support of the company's Healthcare Value Strategy, this position will manage successful implementation of specialty clinical and quality transformation, drive deep transformation engagement with Value Based Specialists, and manage key specialist optimization initiatives. By working closely with our provider partners, this position will identify key drivers for optimizing specialty care for our members, help define deliverables, structure project and provider partner transformation action plans, provide thought leadership, and manage cross-functional teams within a matrix reporting structure toward the end goal of improving longitudinal care outcomes for our members. This senior level position will also serve as a key liaison between Horizon and our strategic provider partners to manage Transformation and Performance Coaching including Quality, Outcomes, Utilization, and Financial Performance; while supporting other key aspects and phases of the relationships. The employee will assist in the development of the long-term operating model for Specialty Performance and Quality Transformation. The role is accountable ensuring success with corporate goals and priorities around achieving the quadruple aim.Responsibilities:

• Manage specialty Clinical Transformation, and specialist optimization for both short and long-term quality performance outcomes improvement, and value optimization with Value Based Specialists and significant provider partners. Deliver high quality, actionable results, ensuring timely completion of deliverables.
• Provide clinical strategic and operational expertise based on extensive knowledge of health care delivery system and provider practices; serve as clinical Value Based SME for clinical innovation/path to other programs.
• Design processes for analyzing, interpreting, and mining available data to gain insights into clinical opportunities that improve outcomes and gain medical cost efficiencies; Initiate transformation with specialists; Facilitate and orchestrate the delivery of program enhancements both internally (cross-functionally) and with provider partners; Act as a liaison to both internal teams and external providers to deploy new programs and concepts; Train, manage, and support Specialty Care Transformation Coaches on transformation initiatives; Monitor performance improvement over time.
• Ecosystem curation to optimize specialty care - develop relationships between primary care, ancillary, multiple specialists, health system, hospitalists to optimize care and remove barriers to care. Integrate behavioral health, SDOH and other health care focus areas to ensure comprehensive transformational work.
• Develop and implement internal and external (provider) processes to support specialist performance improvements.
• Program manage specialist transformation work including:
• Define deliverables and action plans for providers and structured project plans for the overall program to improve on Quality, Utilization, Activity Measures and KPIs.
• Actively drive Horizon owned components of the action plans, including working to remove plan initiated barriers; Support Care Transformation Coaches in progressing the work.
• Monitor program success, use tools to calculate ROI and tracking of progress in key quality, utilization, and activity measures.
• Identify and track risks; Develop, socialize, and ensure implementation of appropriate contingency plans; raise issues to the Director that need to be considered by an executive-level audience./
• Assist Director in providing updates and information across organization; communicate project findings and results to key stakeholders, including Directors and VPs.
• Mentor (Specialty) Care Transformation Coach(es) and Value Based Programs Advisor(s) in clinical and quality transformation work. Manage, develop and train team; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff. Lead staff in working with Value Based specialists to implement clinical initiatives across all other relevant divisions.
• Lead cross-functional teams within a matrix reporting structure (Legal, Finance, HR, MBU, Service, IT, provider partners) to progress specialist transformation work and remove barriers that hinder our provider partners from providing the best longitudinal patient outcomes
• Ensure compliance with any applicable regulations
• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education/Experience:

• High School Diploma/GED required.
• Bachelor degree in clinical, business, or health administration preferred or relevant experience in lieu of degree.
• Master's Degree a plus.
• Requires an active unrestricted RN License.
• Requires direct experience with disease management/preventative management programs/Specialty care.
• Requires experience in a clinical setting such as an hospital or physician office for a minimum of 5 to 7 years.
• Requires broad-based experience with a minimum of 5 years in managed healthcare or related industry with knowledge of interdisciplinary relationships of healthcare functions.
• Requires a minimum of 3 years in a clinical leadership role.
• Prior experience in a strategic role driving innovation, change, and transformation.
• Requires a minimum of 3 years management and supervisory experience.
• Requires experience with health plan and provider quality measures.
• Requires direct experience with using data analysis to drive population health management and process improvement.

Additional licensing, certifications, registrations:

• An active unrestricted RN License (or equivalent).

Knowledge:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.
• Requires broad clinical knowledge and understanding of current health care issues.
• Requires knowledge of health insurance payer business, including operations.
• Knowledge in the principles of Utilization Management and Case Management.
• Strong knowledge of Quality Management.
• Building Strategic Working Relationships: Proactively build effective working relationships; facilitate agreement; clarify current situation; involve appropriate individuals within team and broader organization to achieve desired results.
• Meeting Leadership: Ensures a meeting serves its business objectives; facilitating agreement; develops others' and own ideas; closes discussions with clear summaries.
• Negotiation: Effectively exploring alternatives and positions to reach outcomes that gain the support and acceptance of all parties.
• Business Acumen: Understanding data to identify key issues, and developing strategies and plans.

Skills and Abilities:

• Must be results-driven.
• Exhibits an energetic, inquisitive, positive approach to problem solving.
• Ability to research quality outcomes and cost drivers with providers in such a way that process, practice, and point-of-care improvements and interventions can be identified through strong understanding of patient scenarios, patient care management flows, and provider workflows.
• Ability to research a diverse array of health related topics and distill the key messages.
• Strong relationship management and exceptional interpersonal skills with the ability to build consensus.
• Must be able to interact and influence at the most senior levels of an organization and to work collaboratively across functions, levels and departments toward shared objectives.
• Able to analyze and interpret data to identify clinical opportunities to improve outcomes and cost efficiencies.
• Proven analytical, research and problem solving skills a must.
• Proven ability to ask probing questions and obtain thorough and relevant information.
• Adept at monitoring program success, using tools to calculate ROI and track performance improvements.
• Proven ability to exercise sound judgment.
• Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.
• Planning, Organizational and Project Management skills: Leveraging resources; staying focused; effectively prioritizing and using appropriate tools to drive for results.
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
• Must demonstrate the ability to effectively present information and respond to questions in large and small group settings, and at all organizational levels.
• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to -personal and professional development.
• Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.
• Exhibits proven leadership, delegation and project management skills.
• Proven ability to influence without authority.

Travel :

• Moderate travel required

Salary Range:
$117,100 - $159,810
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.