Business Consultant-Government Programs

Blue Cross Blue Shield of Nebraska; Fort Wayne (IN); Hybrid; USD 60,000 - 100,000; Full time

Job summary

Join a mission-driven organization dedicated to enhancing community health and well-being. This role offers the opportunity to lead strategic initiatives and optimize business processes for government-funded health programs. You'll collaborate with cross-functional teams to ensure compliance with regulations, drive growth in memberships, and develop innovative strategies that align with enterprise goals. If you're passionate about making a significant impact in healthcare and possess a strong background in government programs, this position is a perfect fit for you.

Qualifications

• 5+ years experience in government-funded health insurance, especially Medicare Advantage.
• Leadership experience in Medicare Advantage operations oversight.

Responsibilities

• Lead strategic business processes for government programs like Medicare and Medicaid.
• Ensure compliance with CMS and DOI regulations.

Skills

Government-funded health insurance experience

Claims experience with government programs

Leadership in Medicare Advantage operations

Compliance with Medicare Advantage regulations

Team collaboration

Education

Bachelor's degree

Job description

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. As the industry rapidly evolves, we seek professionals to help us optimize business processes and customer experiences. Join us in delivering on this mission! As a member of Team Blue, you'll find purpose, opportunities, and the support needed to build a meaningful career and make a significant community impact.

BCBSNE offers four work designations for our Omaha-area employees: 100% in-office, hybrid options, and 100% remote. If remote, roles can be located in Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, or Texas. Visits to the office are approximately once a month or as needed.

This role leads the development and execution of strategic efforts and business processes for government programs including Medicare (MA and PDP), Medicaid, ACA, and other health care services funded by State or Federal Governments. The role ensures compliance with all regulations, achieves strategic goals, and maintains exceptional customer experience. It involves leading strategy and innovative business process development aligned with enterprise aspirations, and managing product data strategies. The role also involves developing, implementing, and optimizing business processes grounded in regulatory compliance, analytics, and profitability.

What you'll do:

1. Lead the development of strategic business processes with cross-functional teams including provider contracting, operations, medical management, finance, sales, and compliance for Medicare Advantage, Medicaid, ACA, and other programs.
2. Support the development and execution of provider contracting and reimbursement strategies for Medicare Advantage networks across the state.
3. Ensure all processes comply with CMS, DOI, and other regulations by collaborating with legal and compliance teams.
4. Model BCBSNE's core values and code of conduct, ensuring ethical behavior across the organization.
5. Contribute to growth in Medicare and Medicaid memberships through developing bids and co-leading RFP responses for government contracts.
6. Participate as an effective leader within BCBSNE, demonstrating core leadership principles and values.
7. Develop strategic plans to promote revenue, profitability, and growth in government-funded programs.
8. Monitor regulatory changes and adapt business processes to ensure compliance and strategic alignment.
9. Provide consultative guidance to leadership and collaborate with product, network, insights, marketing, legal, compliance, finance, actuarial, and other teams to develop market-ready products.
10. Support clinical needs understanding to manage population health programs and meet program measures like CAHPS, HEDIS, URAC.
11. Share cross-functional insights on Medicare Advantage market strategy with leadership teams.
12. Communicate initiatives' current and future states to senior leadership.

To be considered, you must have:

• Bachelor's degree and five years' experience with government-funded health insurance such as Medicare Advantage or Medicaid.
• At least five years' claims experience with government programs.
• Leadership experience in Medicare Advantage operations oversight.
• Experience with Medicare Advantage compliance.

An equivalent combination of education and experience may be substituted. Ability to meet attendance and timeliness requirements is essential. Ability to work well in teams and build positive relationships is required.

The strongest candidates will also possess:

• Deep operational experience within government programs.
• Understanding of competitors' strengths, weaknesses, and strategies, with ability to provide market insights.
• Knowledge of current and proposed laws, regulations, and industry trends affecting healthcare.
• Understanding of impacts on consumers and BCBSNE.

Learn more about working at BCBSNE at NebraskaBlue.com/Careers.

We believe diversity of experience, perspective, and background enriches our workplace and enhances our products for members.