field_job_employment_type

job_industry

field_job_occupational_field_parents_all

job_organization_name

The hiring range for this role is: &nbsp;102,640.18 - 158,162.28This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: The role performs policy research and analysis, synthesizes information, and creates communication documents that advance the objectives of Policy and Advocacy. Provides information and reports related to Association legislative and regulatory activities to member Blue Cross Blue Shield Plans, legislators and other interested parties.Responsibilities include but are not limited to: ​<ul><li>Completes policy research and synthesizes information including detailed quantitative analysis of relevant data; researches laws, regulations and legislation to support the policy development process and the creation of policy documents. Includes active participation in cross-divisional policy workgroups. Actively researches and identifies opportunities for BCBSA to support Congressional and Administration priorities which promote relationship building.</li><li>Creates and edits policy documents and memos for dissemination to multiple audiences - internal and external (Plans and congressional and state legislative and regulatory representatives).</li><li>Gathers, edits and assembles information for all policy documents and other communications by soliciting/surveying and collaborating with staff members, researchers, interest groups and Plan members.</li><li>Represents business unit on Association workgroups and serves as point of contact for select ongoing projects.</li><li>Keeps up-to-date on BCBSA legislative strategy, congressional activities, and healthcare issues in order to maintain an understanding of these and incorporate relevant information into analyses and documents. Interacts with internal and other BCBSA staff, Plan staff, interest groups, and vendors.</li></ul>Required Education, Certifications and Experience:Education:<ul><li>Required Bachelor's Degree in Political Science, Policy, Business or related field; or equivalent work experience</li><li>Preferred Master's Degree</li></ul>Experience:<ul><li>5+ Years policy-related experience and/or relevant coursework in health care delivery Required</li></ul> Knowledge Skills and Abilities:<ul><li>Proficiency with the operation of the PC and related software/tools including the Microsoft suite of products</li><li>Competency to solicit input/information from others and translate into written documents/materials</li><li>Comprehensive understanding of health policy issues and the legislative process</li><li>Good communications skills; the ability to communicate effectively, both orally and in writing, as well as knowledge of principles of effective communication</li><li>Strong planning and organizational skills</li><li>Strong human relations skills; and the ability to work with others in obtaining feedback/input, accomplishing goals, and meeting deadlines</li><li>Global thinking skills; informed thinker about issues and their relative impact to how information is communicated</li></ul>Extra Posting information:<ul><li>Minimum of five year of policy-related experience and/or relevant coursework in health care delivery</li><li>Experience researching and synthesizing health care policies and programs including the ability to do detailed qualitative and quantitative analysis.</li><li>Experience writing for healthcare-related publications</li></ul>#LI_HYBRID

Blue Cross Blue Shield Association

Legislative and Regulatory Policy Specialist

The hiring range for this role is: &nbsp;151,694.71 - 233,752.33This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.This role will be a technical expert with deep knowledge of various security domains and underlying technologies. This role will provide strategic and operational leadership in security architecture and engineering, risk analysis, and regulatory compliance. This position will collaborate with stakeholders to enhance the organization's security posture, align security efforts with business objectives, and drive security architecture discipline across the organization.<li>Provide security consulting, design reviews, and recommendations for IT projects and initiatives. Collaborate with stakeholders to ensure secure design and implementation of technical solutions. Partner with Enterprise Architecture to define and promote architecture processes, standards, and patterns. 40%</li><li>Provide leadership in specific security domains/programs, manage multiple related projects, generate roadmaps, drive operational excellence, optimize costs, and enhance security risk visibility. 30%</li><li>Participate in the development and implementation of security architecture principles and standards. Develop and maintain security architecture program metrics for continual improvement. 20%</li><li>Assist stakeholders with research, analysis, development, and implementation of security capabilities focusing on protection, detection, and response. Participate in domain-related incident response efforts and manage domain-specific security tools. 10%</li> Job Overview: This role will be a technical expert with deep knowledge of various security domains and underlying technologies. This role will provide strategic and operational leadership in security architecture and engineering, risk analysis, and regulatory compliance. This position will collaborate with stakeholders to enhance the organization's security posture, align security efforts with business objectives, and drive security architecture discipline across the organization. Essential Functions<ul><li>Provide security consulting, design reviews, and recommendations for IT projects and initiatives. Collaborate with stakeholders to ensure secure design and implementation of technical solutions. Partner with Enterprise Architecture to define and promote architecture processes, standards, and patterns.</li><li>Provide leadership in specific security domains/programs, manage multiple related projects, generate roadmaps, drive operational excellence, optimize costs, and enhance security risk visibility.</li><li>Participate in the development and implementation of security architecture principles and standards. Develop and maintain security architecture program metrics for continual improvement.</li><li>Assist stakeholders with research, analysis, development, and implementation of security capabilities focusing on protection, detection, and response. Participate in domain-related incident response efforts and manage domain-specific security tools.</li></ul>Qualifications<h4>Education </h4><ul><li>Required High School/GED</li><li>Required Bachelor's Degree ; or equivalent experience</li></ul>Experience <ul><li>7+ Years various security domains, including security engineering and information security - Required</li><li><h4>Experience driving the integration of advanced network security and resiliency across the technology engineering and operations function - Required </h4></li><li><h4>Experience enabling and supporting platforms such as Zscaler, Microsoft 365, AWS Cloud and AWS Cloud Security, Akamai, and modern data protection and network security solutions - Required</h4></li></ul><h4>Knowledge Skills and Abilities </h4><ul><li>Advanced understanding of security controls and regulatory compliance frameworks (NIST, ISO, HITRUST, HIPAA) Proficiency in scripting languages (Python preferred), API integrations, and process automation Expertise in web application security, cryptographic algorithms, PKI, and networking fundamentals Excellent communication and presentation skills for both technical and non-technical audiences Advanced analytical and problem-solving skills, with the ability to manage multiple projects successfully Ability to influence and solve problems effectively across project teams and senior management Demonstrated ability to make operational decisions, monitor progress, and report results</li></ul> Extra Posting information: Minimum 7 years in various security domains, including security engineering and information security

Senior Security Engineer

The hiring range for this role is: &nbsp;85,126.50 - 126,003.57This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: Manages and conducts investigations related to fraud, theft, and other criminal activities within an organization. Develops and implements fraud prevention programs and strategies to mitigate risks and protect assets. Collaborates with law enforcement agencies, legal teams, and internal stakeholders to gather evidence, interview witnesses, and build cases for prosecution. Provides expert guidance and advice on fraud detection techniques, compliance regulations, and best practices in fraud prevention. Analyzes data, trends, and patterns to identify potential fraudulent activities and develop proactive measures to prevent future incidents. Conducts training sessions and workshops to educate employees on fraud awareness and prevention strategies.Responsibilities include but are not limited to: ​<ul><li>Education and Training: Develop communication materials and provide training for assigned contract requirements, compliance systems, and program standards. 20%</li><li>Documentation and Reporting: Prepare necessary reports and forms, maintain documentation to support contract and Carrier Letter requirements, and ensure timely and accurate records of case developments. 20%</li><li>Investigative Coordination: Coordinate investigative efforts among BCBS Plan Special Investigation Units (SIUs), assigned contract Pharmacy Benefit Managers (PBMs), law enforcement agencies, and other stakeholders. Provide summaries for BCBSA Legal Department and Office of Personnel Management-Office of the Inspector General, support health care fraud investigations, and deliver case presentations to U.S. Attorney Offices, as required. 20%</li><li>Subject Matter Expertise and Research: Support SIU staff as a subject matter expert (SME) on all required tracking systems. Conduct research and assist in developing anti-fraud training for assigned Plan and applicable PBM SIU staff. 15%</li><li>Relationship Building and Special Projects: Develop and maintain productive working relationships with various local, state, and federal law enforcement agencies and industry partners. Assist with special projects, including training new staff and revising applicable Standards Manuals. 15%</li><li>Programmatic Guidance and Corrective Actions: Provide programmatic Fraud, Waste &amp; Abuse (FWA) guidance and input to PBMs, Plan SIUs, and internal BCBSA business units. Recommend and implement corrective actions to mitigate identified risks and recommend updates to processes, benefits, and protocols. 10%</li></ul>Required Education, Certifications and Experience:Education:<ul><li>Required Bachelor's Degree or equivalent work experience</li></ul>Experience:<ul><li>4+ Years experience in law enforcement, Healthcare Fraud Investigations, nursing, healthcare plan operations, or related fields Required</li></ul>Knowledge Skills and Abilities:<ul><li>Excellent written and verbal communication skills.</li><li>Excellent organizational and time management skills.</li><li>Strong training and presentation skills.</li><li>Ability to research and analyze data/information and apply it appropriately and accurately.</li><li>Strong interpersonal skills and relationship development abilities.</li><li>Demonstrated technical proficiency in the use of various computer software programs, including Microsoft Office applications and databases.</li><li>Ability to exercise independent judgment to facilitate responses to inquiries/questions.</li><li>Knowledge of the Federal Employee Health Benefit Program (FEHBP).</li></ul>Certifications &amp; Licenses:<ul><li>Preferred: AFI</li></ul>Additional information:<ul><li>Five or more years of experience in law enforcement, Healthcare Fraud Investigations, nursing, healthcare plan operations, or related fields.</li><li>Experience in analyzing and responding to complex sets of information and/or processing information requests.</li><li>Prior federal, state, or local law enforcement experience.</li><li>Prior health care fraud investigative experience and/or clinical experience.</li><li>Nursing or medical coding experience.</li><li>Criminal justice experience</li><li>Prior BCBS Plan experience</li></ul>#LI_HYBRID

Fraud Investigations Consultant

The hiring range for this role is: &nbsp;131,908.44 - 203,262.90This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: This role is responsible for the overall delivery of technical solutions initiatives. Serves as the primary point of contact for the delivery, operations, and support of complex technology solutions. Work cross-departmentally and cross-organizationally to ensure the successful delivery of technology solutions initiatives. Interface with all levels of management, business owners, technical owners, team members, information security, and vendors/partners to define project priorities and outcomes. Oversee the build and deployment of complex solutions for customers using innovative automation tools, modern technologies and effective use of managed staff assigned to various IT efforts, to ensure successful delivery of initiatives.Responsibilities include but are not limited to: ​<ul><li>Serve as the primary point of contact within the organization for business, information security, and IT leadership, ensuring the successful delivery of assigned technical solutions. Coordinate cross-functional efforts to meet delivery objectives.</li><li>Establish and maintain effective controls for technical solution delivery initiatives. Define overall solution scope with business and project management office, estimate requested scope, and identify team resource capacity. Balance scope estimates and capacity to ensure successful delivery, address gaps, and document technical delivery roadmap.</li><li>Provide cross-team leadership to drive technical solution delivery to a successful conclusion. Proactively identify and address issues, maintain momentum, and implement solutions.</li><li>Collaborate effectively across all teams, navigate solutions to issues with a win-win approach, and maintain positive working relationships with all stakeholders.</li><li>Apply technical skills in the development and delivery of technical solutions as needed, following established methodology processes and practices.</li><li>Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals.</li></ul>Required Education, Certifications and Experience: Education:<ul><li>Required Bachelor's Degree in computer science, Information Systems, Business Administration, or equivalent work experience.</li><li>Preferred Master's Degree in Computer Science, Information Systems, Business Management, or equivalent work experience.</li></ul>Experience:<ul><li>7+ Years IT work experience, including application system architecture, design, development, and implementation Required</li></ul> Knowledge Skills and Abilities:<ul><li>Effective communication, presentation, and leadership skills</li><li>Advanced technology project management skills</li><li>Extensive knowledge of modern data processing platforms, cloud computing, object-oriented analysis/design, data lakes, data warehouses, data sharing, security, analytics, AI/ML, and Gen AI</li><li>Ability to resolve conflicts between timeline, budget, and scope independently, with escalation of complex issues as needed</li><li>Deep understanding of cloud security, including techniques for protecting sensitive data (PHI/PII) such as encryption, masking, and tokenization</li><li>Knowledge of healthcare legal and regulatory requirements (HITRUST, SOC-2, HIPAA Privacy &amp; Security, CMS regulations)</li><li>Excellent interpersonal, presentation, and communication skills</li><li>Ability to research and apply emerging technologies to the business</li><li>Advanced analytical, information security, and conceptual skills</li><li>High attention to detail, well-organized, and a self-starter</li></ul>Certifications &amp; Licenses:<ul><li>Required: AWS Certified Developer - Amazon Web Services (AWS)</li></ul>Additional information:In addition to ensuring the effective delivery of technical initiatives, this position provides strategic leadership and expert guidance for a team of Systems Analysts overseeing a large clinical data warehouse and ecosystem. The role emphasizes technical excellence in data analysis, modeling, and the design of advanced data environments, while cultivating continuous professional growth within the team. Additional experience with the following will be needed:<ul><li>Stewarding data quality and governance practices</li><li>Developing key technical documentation and systems requirements</li><li>Aligning evolving data management strategies with organizational objectives.</li></ul>Additional Knowledge, Skills, Abilities<ul><li>Demonstrated leadership in guiding, coaching, and empowering team members to achieve collective and individual goals, fostering a culture of collaboration, continuous learning, and professional growth.</li><li>In-depth knowledge of system analysis, design, and implementation, as well as staying updated with industry standards and technologies.</li><li>Ability to identify and resolve complex system issues and make informed decisions.</li><li>Proficiency in developing logical and physical data models, establishing data relationships, and ensuring data integrity across diverse platforms.</li><li>Skilled in leveraging data profiling techniques to assess the quality, consistency, and completeness of datasets, identifying anomalies, and recommending strategies for continuous improvement.</li><li>Strong analytical skills to evaluate system performance and identify areas for improvement.</li><li>Strong familiarity with specialized tools and methodologies.</li></ul>#LI_HYBRID

Senior Manager Product Engineering (Systems Analysis)

The hiring range for this role is: &nbsp;104,195.33 - 160,558.68This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: This position will directly support the key activities of Licensing &amp; International team, which includes establishing strong working relationships with Plan leadership and International Licensees, &nbsp;supporting daily license related business activities, assessing potential impacts of proposed initiatives/solutions to Plans, International licensees and the broader BCBS system, supporting pilot programs, as needed, and accelerating the adoption of best practices as is relates to licensing efforts among BCBS Plans.&nbsp;&nbsp; This is an ideal opportunity for an early career professional looking to deepen their exposure to the healthcare ecosystem, global healthcare, licensing and business development activities. Core responsibilities will include, but are not limited to daily project management/support, Licensee/Plan engagement, execution of business development opportunities and managing strategic initiatives with minimal oversight. Additional details can be found in the job description.Responsibilities include but are not limited to:<ul><li>Independently manages key components and projects that support projects and programs, which may include contracting, program design, implementation or the synthesis and reporting of program results.</li><li>Collaborates across departments and divisions at BCBSA and acts as project manager for cross-functional efforts and other internal divisions where projects necessitate support.</li><li>Mobilizes Plan engagement and participation in local pilots and national programs and act as liaison between Plans and external partners.</li><li>Prepares executive-level deliverables summarizing program and team initiatives and updates (i.e. PowerPoints, executive briefs or summaries, etc.).</li><li>Delivers compelling, persuasive and succinct updates and program opportunities to BCBS Plans, leadership and external partners via workgroups meetings, webinars, in-person meetings and other forums.</li></ul>Required Education, Certifications and Experience: Education:<ul><li>Required Bachelor's Degree in business, engineering, pre-med/healthcare administration or other business major; or equivalent work experience</li></ul>Experience:<ul><li>5+ Years health or business related experience; previous positions within corporate development, strategy, program management or consulting firms Required</li></ul>Knowledge Skills and Abilities:<ul><li>Flexibility around change/ambiguity, ability to manage priorities in alignment with broader team objectives.</li><li>Demonstrated success establishing and growing relationships with third party organizations.</li><li>Proficiency with the use of a variety of software applications (e.g., Microsoft Word, Excel, PowerPoint and WebEx).</li><li>Excellent verbal and written communication skills.</li><li>Strong business acumen, analytical problem solving and organizational skills; demonstrated ability to work both creatively and in alignment with structured objectives in remote environment.</li></ul>Additional information:<ul><li>Five or more years of health or business related experience; previous positions within corporate development, strategy, program management or consulting firms</li><li>Experience managing complex projects with multiple stakeholders.</li></ul>#LI_HYBRID

Development and Partnerships Strategic Account Manager

The hiring range for this role is: &nbsp;142,690.17 - 219,876.89This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: The Litigation &amp; Risk team identifies, mitigates, and manages Blue Cross Blue Shield Association's (BCBSA) risks, including litigation-related risk having a significant impact on BCBSA and BCBS Plans. This role manages and collaborates across the organization to provide legal team support of Systemwide litigation, including partnering with outside counsel on discovery and case strategy, managing within a litigation budget, collaborating with BCBSA leadership and Blue System litigation counsel on case strategy, and supporting business teams with of Systemwide business changes. Additionally, this role provides legal advice and counsel to BCBSA leadership on the operation of BCSBA’s antitrust compliance program.Responsibilities include but are not limited to:<ul><li>Assigned practice area may include one or more of the following litigation, special investigations, legal operations, healthcare/regulatory law, contracts, etc.</li><li>Identify and assess legal risks for moderately complex matters for assigned practice area with minimal supervision and direction. Assigned practice area may include one or more of the following litigation, special investigations, legal operations, healthcare/regulatory law, contracts, etc. 30%</li><li>Builds knowledge of the business context 30%</li><li>Performs routine legal work. 20%</li><li>Handles moderately complex legal questions and projects. 20%</li></ul>Required Education, Certifications and Experience: Education:<ul><li>Required Juris Doctor</li></ul>Experience:<ul><li>5+ Years legal practice experience required</li></ul>Knowledge Skills and Abilities:<ul><li>Strong written and oral communication skills</li><li>Strong organizational and project management skills, including follow through skills</li><li>Strong legal research, analysis and drafting</li><li>Problem solving skills</li><li>Preferred knowledge of healthcare insurance industry, including state and federal regulatory environment</li></ul>Certifications &amp; Licenses:<ul><li>Required: Bar Admission - Various</li></ul>Additional information:<ul><li>Legal practice experience, practice experience in contracts, corporate law, health law, HIPAA/privacy, litigation, and/or health insurance law</li><li>Knowledge, Skills and Abilities:</li><li>Strong written and oral communication skills</li><li>Strong organizational and project management skills, including follow through skills</li><li>Strong legal research, analysis and drafting</li><li>Problem solving skills</li><li>Preferred knowledge of healthcare insurance industry, including state and federal regulatory environment</li></ul>#LI_HYBRID

Associate General Counsel

The hiring range for this role is: &nbsp;$103,676.95 - $159,759.88This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation.<li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed 25%</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval 25%</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations 25%</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives 15%</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations 10%</li> Job Overview: Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation. Essential Functions<ul><li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations</li></ul>QualificationsEducation <ul><li>Required Bachelor's Degree in nursing or related field from an accredited university; or equivalent work experience</li><li>Preferred Master's Degree</li><li>Experience </li><li>5+ Years of experience with Utilization Management and Medical Policy development in a managed care setting Required</li><li>Knowledge Skills and Abilities </li><li>Excellent written and verbal communication skills Ability to translate complex, technical and/or quantitative information in clear, concise, and understandable documents of presentation Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics Demonstrated ability to identify and create strategies that support initiatives and translate these into strategic action plans Ability to work well in an interdisciplinary clinical team environment Demonstrated ability to foster strong working relationships with customers and business stakeholders and contact Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting deadlines Ability to lead independent research Technical proficiency with information technologies (e.g. Microsoft Office) and literature-search databases Demonstrated abilities in data analysis, synthesis, and reporting, including systematic analysis of clinical literature Ability to conduct comparative analysis of external medical policies, with detailed analysis of specific clinical indications Demonstrated ability to understand complex medical technology assessments and detailed analysis of specific clinical indications in medical policies</li><li>Certifications &amp; Licenses </li><li>Required: RN-CS - RN Certified Clinical Specialist -</li><li>Preferred: CPHM - Certified Professional in Healthcare Management - AIHM</li><li>Preferred: Certified Professional Coder (CPC) - AAPC</li><li>Preferred: Accredited Case Manager (ACM) - ACMA</li></ul> Extra Posting information: A minimum of four years of experience with Utilization Management and Medical Policy development in a managed care setting. Experience with URAC/NCQA accreditation requirements. Experience presenting information to large audiences (town hall calls, professional conferences, etc.), both virtually and in-person. Experience in leading cross-functional work Experience related business experience which demonstrates knowledge and understanding of PPO operations, business practices and processes, as well as knowledge of corporate goals.#LI-Hybrid

Utilization Senior Program Manager (Registered Nurse)

The hiring range for this role is: &nbsp;162,996.28 - 244,494.42This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: Responsible for providing technical leadership, analysis and design facilitation across business, information, technical and solution viewpoints and enterprise architecture. In conjunction with the chief architect, responsible for leading the effective integration of the Enterprise Architecture process with other related processes (i.e., investment, enterprise program, IT portfolio and project management) in the organization.Perform cost-benefit analysis to determine appropriate architectural approaches for multiyear business initiatives and architecturally significant projects. Incorporate Architectural Trade-off Analysis Method (ATAM) and Cost-Benefit Analysis Method (CBAM). Perform top-down, order-of-magnitude estimates for technology development and operational activities. Develop and refine order-of-magnitude estimating models based on previous project actual costs and trends to improve accuracy of estimates. Provide Subject Matter Expert (SME) services to individual projects in the areas of architectural and technology selection decisions. Conduct research in emerging technologies and continuously identify technologies with high-potential business value and specify their appropriate usage in developing business solutions. Conduct technology trends studies and publish trend reports on an annual basis. Develop and integrate technology acceleration and innovation processes with the overall project management practices, E2E process, and software development lifecycle.Responsibilities include but are not limited to: ​<ul><li>Analyze objectives and goals to identify common patterns, leverage points and consistent business needs across multiple business units and initiatives. Develop reference architectures and models for the major architectural domains: business, information, technical, and system architectures. Define multi-year architectural evolution and roadmaps for major products that align with the reference architectures. 25%</li><li>Analyze the business strategy of the Association and of the individual business units to define an IT strategy and enterprise architecture that enables the successful execution of the business strategies. Break down the business objectives and strategies into technical initiatives spanning multiple programs, projects, products, and releases. 25%</li><li>Serve as expert level advisor to business and IT management on architectural and technology topics, best practices, risks and opportunities. Represent BCBSA’s architectural vision and strategic technology positioning at Association, Plan, and Industry-wide forums and events. Write and publish whitepapers and positioning documents representing BCBSA’s vision and opinion on architectural and technology topics with Blue system-wide and industry-wide significance. 20%</li><li>Provide clear direction, coaching and support to business and technical staff on project teams. Recommend, define, and establish cross functional organizational structures that facilitate the successful achievement of architectural consistency and business alignment. 15%</li><li>Define architectural and technology standards. Establish Architecture Assurance processes and integrate them with the overall Association project management practices, E2E process, and software development lifecycle. Operate the BCBSA Architecture Review Board (ARB) as part of the Architecture Assurance process. Develop architectural templates and other standard artifacts to facilitate the Architecture Assurance process. Follow good documentation practices including producing and managing formal artifacts, as well as writing clean, readable, and standards-compliant architectural artifacts. 10%</li><li>Review and approve architectural documents 5%</li></ul>Required Education, Certifications and Experience:Education:<ul><li>Required Bachelor's Degree in Computer Science or Engineering, Information Systems, Business Administration, Engineering or Science field, or equivalent work experience in similar work environment.</li><li>Preferred Master's Degree in Computer Science, Information Systems, Business Administration, or Management</li></ul>Experience:<ul><li>10+ Years IT or software development work experience including enterprise architecture, software and system architecture, business analysis and business process architecture, application system design and implementation, technical team leadership Required</li></ul>Knowledge Skills and Abilities:<ul><li>In-depth knowledge of state-of-the-art programming languages and object oriented approaches in designing, coding, testing and debugging programs</li><li>Extensive use of Project Management methodologies</li><li>Expert level understanding of the health insurance industry preferred</li><li>Advanced analytical and conceptual skills</li><li>Ability to create original concepts/theories for various projects</li><li>Advanced leadership skills</li><li>Ability to perform cost benefit analysis, business case development, and financial justification</li><li>Excellent presentation and communication skills</li><li>Understands and consistently applies the attributes and processes of current application development methodologies</li><li>Strong research skills in emerging technologies and possible application to the business</li><li>Ability to maintain key relationships to achieve business objectives </li></ul>Additional information:<ul><li>Preferred: Minimum 15 years of IT or software development work experience including enterprise architecture, software and system architecture, business analysis and business process architecture, application system design and implementation, technical team leadership.</li></ul>#LI_HYBRID

Lead Enterprise Architect

The hiring range for this role is: &nbsp;92,787.88 - 139,616.25This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.This role is responsible for leading and managing small to mid-size projects and portions of larger projects addressing critical strategic issues for the Blue System. The role is responsible for applying analytical rigor (e.g., data collection and analysis) and executing primary and secondary research, including BCBS Plan input. The position will be able to identify actionable insights and share with non-technical audiences, including senior leadership. The role requires attention to detail, collaboration and project management. He/she/they will communicate up, down and around to keep business partners engaged and motivated to act on strategic insights.<li>Develop executive deliverables and present findings to inform and influence key decision makers. 30%</li><li>Conduct primary/secondary research, synthesize findings, and identify strategic recommendations. 25%</li><li>Project lead for mid-size projects and portions of larger projects 25%</li><li>Support strategic planning including BCBS Plan engagement. 15%</li><li>Provide coaching and oversight to junior staff 5%</li> Job Overview: This role is responsible for leading and managing small to mid-size projects and portions of larger projects addressing critical strategic issues for the Blue System. The role is responsible for applying analytical rigor (e.g., data collection and analysis) and executing primary and secondary research, including BCBS Plan input. The position will be able to identify actionable insights and share with non-technical audiences, including senior leadership. The role requires attention to detail, collaboration and project management. He/she/they will communicate up, down and around to keep business partners engaged and motivated to act on strategic insights. Essential Functions<ul><li>Develop executive deliverables and present findings to inform and influence key decision makers.</li><li>Conduct primary/secondary research, synthesize findings, and identify strategic recommendations.</li><li>Project lead for mid-size projects and portions of larger projects</li><li>Support strategic planning including BCBS Plan engagement.</li><li>Provide coaching and oversight to junior staff.</li></ul>Education <ul><li>Required Bachelor's Degree in related discipline; or equivalent work experience.</li><li>Experience </li><li>5+ Years related business experience Required</li><li>Experience with business/product strategy development and application of analytical methods.</li><li>Strong project lead experience in preparing work plans leading small to mid-sized projects and portions of larger projects.</li><li>Knowledge Skills and Abilities </li><li>Experienced analytical and creative problem-solving skills to lead hypothesis development and integration. Competency to generate actionable insights from analytical work. Effective written and verbal communication skills, including facilitation and presentation abilities. Demonstrated ability to work independently. Familiarity with health insurance industry and concepts. Proficient relationship building and influence skills. Mentoring skills: ability to mentor junior staff and aid in career development.</li></ul>#LI-Hybrid

FEP Strategy Senior Consultant

The hiring range for this role is: &nbsp;102,640.18 - 158,162.28This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.The role develops policy recommendations that further the BCBS mission and drive solutions. Identifies and analyzes proposed regulatory and legislative initiatives at the federal and state level which present significant implications to BCBS Plans' members and clients. Identifies policy questions, advances meaningful policy solutions, and builds consensus with BCBS Plans and stakeholder allies on high-profile issues. Prepares formal comments regarding recommended policies and communicates key updates from BCBSA and federal/state policymakers to BCBS Plans. Works closely with BCBSA leadership to develop strategy around regulatory and legislative priorities for engagement with the White House, Administration, Congress and other key stakeholders in Washington.<ul><li>Supports the development of effective, consensus-based policy recommendations to promote BCBSA and BCBS Plan objectives at both state and federal levels. Manages the review of legislation and regulations to identify and provide feedback to policymakers and staff on strategic and business considerations. Develops advocacy documents to support these activities, including key messaging, one-pagers, and briefing materials. Provides policy support for coalitions, third-party inquiries and internal business partners on select focus areas. Brings forward new ideas and strategic thinking to promote BCBSA priorities and objectives. 20%</li><li>Manages projects within assigned regulatory and legislative focus areas, including the identification of key business issues, legislative or regulatory analysis. Develops comment letters and resources for policymakers and educational materials for BCBS Plans. 20%</li><li>Leads workgroup calls on focus areas. Identifies and communicates key regulatory and legislative activities to internal audiences, BCBS Plans and other external audiences. Participates in and contributes to cross-departmental and cross-divisional meetings and workgroups to provide political and policy insights. 20%</li><li>Maintains acute awareness of legislative and regulatory positions, priorities, strategies, federal policymaking activities, external stakeholder positioning, and health care issues. Provides policy support to State Affairs team and work with state-based organizations (SBOs). Takes on various health policy projects as assigned. 20%</li><li>Collaborates with BCBS Plan representatives, business unit teams and broader BCBSA staff. Engages with external stakeholders including federal policymakers and third-party representatives as appropriate. 15%</li><li>Ensures senior management, senior leadership team and BCBS Plan representatives are informed as to pertinent legislative and regulatory developments. 5%</li></ul> Job Overview: The role develops policy recommendations that further the BCBS mission and drive solutions. Identifies and analyzes proposed regulatory and legislative initiatives at the federal and state level which present significant implications to BCBS Plans' members and clients. Identifies policy questions, advances meaningful policy solutions, and builds consensus with BCBS Plans and stakeholder allies on high-profile issues. Prepares formal comments regarding recommended policies and communicates key updates from BCBSA and federal/state policymakers to BCBS Plans. Works closely with BCBSA leadership to develop strategy around regulatory and legislative priorities for engagement with the White House, Administration, Congress and other key stakeholders in Washington. Supports our prescription drug policy (e.g., Rx reform, pharmacy benefit manager issues, and cell &amp; gene therapies) and policies to improve health care affordability. Essential Functions<ul><li>Supports the development of effective, consensus-based policy recommendations to promote BCBSA and BCBS Plan objectives at both state and federal levels. Manages the review of legislation and regulations to identify and provide feedback to policymakers and staff on strategic and business considerations. Develops advocacy documents to support these activities, including key messaging, one-pagers, and briefing materials. Provides policy support for coalitions, third-party inquiries and internal business partners on select focus areas. Brings forward new ideas and strategic thinking to promote BCBSA priorities and objectives.</li><li>Manages projects within assigned regulatory and legislative focus areas, including the identification of key business issues, legislative or regulatory analysis. Develops comment letters and resources for policymakers and educational materials for BCBS Plans.</li><li>Leads workgroup calls on focus areas. Identifies and communicates key regulatory and legislative activities to internal audiences, BCBS Plans and other external audiences. Participates in and contributes to cross-departmental and cross-divisional meetings and workgroups to provide political and policy insights.</li><li>Maintains acute awareness of legislative and regulatory positions, priorities, strategies, federal policymaking activities, external stakeholder positioning, and health care issues. Provides policy support to State Affairs team and work with state-based organizations (SBOs). Takes on various health policy projects as assigned.</li><li>Collaborates with BCBS Plan representatives, business unit teams and broader BCBSA staff. Engages with external stakeholders including federal policymakers and third-party representatives as appropriate.</li><li>Ensures senior management, senior leadership team and BCBS Plan representatives are informed as to pertinent legislative and regulatory developments.</li></ul>Qualifications<ul><li>Education </li><li>Preferred Bachelor's Degree or equivalent work experience</li><li>Experience </li><li>5+ Years equivalent work experience Required</li><li>Knowledge Skills and Abilities </li><li>Working knowledge of health care systems and understanding of legislative and policymaking process. Good communications skills; the ability to communicate effectively, both orally and in writing Strong planning and organizational skills Strong human relations skills; and the ability to work with others in obtaining feedback/input, accomplishing goals, and meeting deadlines Comprehensive understanding of health policy issues and the legislative process, as well as experience with policy writing Excellent interpersonal skills; demonstrated ability to develop and maintain relationships and influence outcomes Excellent verbal and written communication skills, with the ability to identify issues and develop appropriate advocacy recommendations Ability to manage time and competing priorities.</li><li>Five or more years of equivalent work experience Experience working on one or more of the following health policy areas :Health equity, which may include social determinants of health, standardizing health equity data or maternal health equity Medicare and/or Medicaid issues which may include Stars, quality, prior authorization, dual eligibleHealth insurance contracts and payment structures in Medicare/Medicaid and/or commercial lines of business (LOBs)Prescription drug issues (Rx reform, pharmacy benefit manager, opioid use disorder, cell &amp; gene therapies), Pharmacy benefits for commercial, Medicare and Medicaid LOBsImproving affordability of health care, and value-based care programs including relevant regulation, legislation and/or lawHealth IT which may include AI, cybersecurity, technical and market issues related to data operations, standards development, application programming interfaces, data privacy and security issues, and third-party application capabilities Experience developing and drafting policy and legal analysis with focus on above programs and/or issue areas. Experience working for Congress, the Administration or third-party stakeholders focused on above programs and/or issue areas. Experience working with public officials or in government.</li></ul>Knowledge, Skills and Abilities: Working knowledge of health care systems and understanding of legislative and policymaking process. Good communications skills; the ability to communicate effectively, both orally and in writing Strong planning and organizational skills Strong human relations skills; and the ability to work with others in obtaining feedback/input, accomplishing goals, and meeting deadlines Comprehensive understanding of health policy issues and the legislative process, as well as experience with policy writing Excellent interpersonal skills; demonstrated ability to develop and maintain relationships and influence outcomes Excellent verbal and written communication skills, with the ability to identify issues and develop appropriate advocacy recommendations Ability to manage time and competing priorities#LI-Hybrid

18 Blue Cross Blue Shield Association Jobs