Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid – 3 days in office, Hybrid – 2 days in office, 100% remote. Occasional visits to the office.

The role of the Manager Care Management Government Programs manages and directs the activities and functions of a multifaceted care management team for ACA (Affordable Care Act) members and other government lines of business. This role approaches every new member care management outreach effort as an opportunity to assure member engagement is achieved in care efforts, and collaborates with other departments and businesses, as necessary, to meet key stakeholders and member educational needs, owning the end-to-end delivery of Utilization Management and Care Management care models for this line of business.

What you'll do:

• In collaboration with the Director, participates in preparation and execution of department budget

• Integrates clinical quality and risk data from present IT systems, collaborating with key stakeholders on reporting data and performing analytics to improve overall patient care quality

• Participates as a member of management staff in examining member level needs and issues as identified by key performance indicators.

• Works closely with other managers in the development; Implementation and monitoring of new and/or revised service programs or delivery methods.

• Develops and establishes Workforce Management performance goals and assesses performance goals at the direction of the Director.

• Monitors service delivery and implements organizational changes necessary to achieve goals and objectives.

• Develops and/or revises and oversees implementation of operating plans and procedures in accordance with overall departmental/divisional goals and objectives, and in compliance with URAC and other regulatory requirements.

• Plans, assigns, reviews, and evaluates the work of supervisory staff responsible for effective delivery of services.
• Identify opportunities for scalability and tactics to increase productivity and efficiencies.
• Organize and integrate cross functional activities, ensuring successful completion of projects within appointed time and within budget constraints.
• Develop and improve robust analysis and reporting tools and methodologies resulting in greater understanding of costs and product performance to drive program change and priority.
• Provides guidance to clinical business analyst to analyze trends and gathers input critical to accurate forecasting in accordance with department goals and objectives.
• Applies knowledge of the principles and practices of care management administration; social work/case management theory and practices; managerial principles and practices; community services and resources available; member population; as well as the knowledge required of Registered Nurses.

To be considered for this position, you must have:

• Current, unrestricted Registered Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates.
• Bachelor’s Degree in Health-Related Field and three (3) years clinical practice experience in a health care setting. An equivalent combination of education and experience may be substituted to meet this requirement.
• Demonstrated experience in business modeling and analysis
• Previous management experience (3+ years) with proven track record of managing programs, projects and initiatives in an operations or care management environment
• Proven ability to coordinate the activities of cross-functional programs and projects with multi-disciplinary teams
• The ability to meet or exceed the attendance and timeliness requirements of their departments.

The strongest candidates for this position will also possess:

• Previous experience in managed care for Medicaid, Medicare, or other government programs.
• Existing community and professional contacts within the market and knowledge of community resources
• Master’s Degree in a Health-Related Field
• Certification in case management

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans