Accountable for collaborating with business teams to provide clinical input related to the design of programs and healthcare benefits. Provides direction for multiple projects, pilots, services and associated deliverables and/or impact related to FEP Benefit Delivery. Serves as the clinical liaison to the Office of Personnel Management (OPM) to discuss various policy/benefit management inquiries.
Responsibilities include but are not limited to:
Serves as a clinical consultant in the design, implementation, and interpretation of medical benefits. Works collaboratively and cross-functionally to ensure alignment and operational success.
Leads clinical discussions with the Office of Personnel Management (OPM) for benefit negotiations and brochure changes and clarifications.
Leads cross-functional projects/teams working with PMO to develop project scope and outcome measures, assuring that operational components are addressed to meet Plan business needs and execution while ensuring projects and pilots are aligned with FEP strategic direction.
Required Basic Qualifications:
Preferred Basic Qualifications:
Graduate degree Utilization Management Benefit Design
Academy of Healthcare Management certification Licensed in a clinical field by the appropriate board
Equal Opportunity Employer
Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics
Blue Cross And Blue Shield Association