Description:
Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.

The Vice President for Health Management Programs has lead accountability for the planning, development and management of key health management initiatives focused on helping the company to maintain its market leadership and cost competitiveness positions in the industry. Reporting to the Senior Vice President of Health and Wellness, the Vice President has both significant internal and external responsibilities. He/she will provide direct leadership to the clinical staff involved in case management, behavioral health and utilization management within the Health and Wellness Division. He/she will also play a lead role in efforts to achieve a new end-to-end integrated model of programs that reduce medical costs, eliminate clinical waste and improve our members' health. External responsibilities include assessment of industry trends and maintaining relationships with healthcare industry and community groups. The Vice President for Health Management Programs will also partner with colleagues from within Health and Wellness, Medical Innovation and Leadership and Sales on key internal and account-facing initiatives and in conveying the value of our health management programs to major accounts and brokers.

Key responsibilities include the following

• Provide effective leadership and support to all staff engaged in BCBSMA health management programs; promoting a culture of excellence, accountability and results.


• Understand the key drivers of our medical expense and trend, and the clinical demographics, utilization and outcomes of our members. Based on that understanding, develop new programs and services and manage existing programs to achieve measurable results in health outcomes and trend reduction.


• Identify health management best practices and new solutions to improve the quality, safety, and effectiveness of the care received by our members.


• Play a key role in the development and effective implementation of new integrated health management solutions and programs.


• Expand and enhance behavioral health programs for BCBSMA members and integrate the delivery of those programs with medical care management.


• Partner with leaders in Health Care Contract and Network Management to develop the goals, contract specifications and performance measures for any outsourced health management programs.


• In partnership with SVP for Health Care Contract and Network Management, the Executive Director of Transformation and the Medical Directors, develop a framework and a continuum of models for integrating BCBSMA health management programs into the efforts of delivery system providers.

Qualifications and Experience

• Demonstrated success as a leader with the ability to articulate and execute an enterprise-wide vision and strategic priorities that create alignment within the organization as well as the tactical ability to develop and implement programs that achieve targeted goals.


• 10-12 years of professional experience in health care administration, including 8-10 years of experience in the analysis and interpretation of clinical and medical expense trend data. A clinical background is strongly preferred.


• Demonstrated success and a minimum of 5 years of experience in creating programs, initiatives and business strategies which have had short- and long-term, positive impacts on medical expense trend.


• Excellent organizational, analytical and problem-solving skills. Experience in analyzing problems using a team approach and in leading high-level cross-functional teams.


• Demonstrated success in building and leading high-performing organizations and in developing high-performing, high-potential leaders and associates


• Demonstrated executive presence and the demonstrated ability to interact effectively with executives, leaders and associates at every level of the organization. Success as a team player, able to build both internal and external consensus


• Superior communication, listening and presentation skills.


• Experience working collaboratively with multiple internal and external constituencies.


• Successful track record of managing multiple budgets. Experience effectively managing large numbers of staff, performance management systems and other human resource issues.


• Demonstrated ability to achieve results through influence as well as direct control.

Experience and Education:

• Bachelor's degree in a clinical discipline, from an accredited college or university is required. An advanced degree is preferred.