VP Case & Condition Management Programs - Hybrid (PA/NJ/DE)

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); Hybrid; USD 200,000 - 260,000; Full time

Job summary

Independence Blue Cross seeks a visionary Vice President of Case & Condition Management Programs to guide the design and execution of comprehensive case and population health programs across the organization. This hybrid role aligns clinical strategy with regulatory and business objectives, delivering high-quality, affordable care for members in a complex multi-state network.

The role emphasizes leadership of large teams, partner coordination with providers and vendors, and driving performance

Qualifications

• Active state license in required practicing states without probationary status.
• Minimum 10 years of progressive leadership in case/condition management operations.
• Experience leading large clinical and non-clinical staff with increasing responsibility.
• Strong collaboration and consensus-building skills across multiple functions.
• Excellent verbal and written communication and leadership abilities.
• Experience with budgeting, planning, and staff supervision preferred.

Responsibilities

• Provides leadership in development of case and condition management and population health programs.
• Collaborates across departments to develop, implement, monitor and manage programs meeting market demands and improving clinical outcomes.
• Owns strategic approach for case and population health activities across partners to minimize duplication and enable integrated services.
• Advances adoption of AI, analytics, and automation to improve efficiency and decision-making.
• Oversees management of associates and vendors to improve HEDIS, CMS Star ratings, and adherence measures.
• Oversees an integrated autism services model unit ensuring coordinated, person-centered support.
• Ensures all activities meet quality, compliance, regulations, and productivity targets.

Education

Active state license to practice

Medicare/Medicaid & Federal DEA compliance

10 years leadership in case/condition management

3+ years leading large clinical/non-clinical teams

Collaboration with cross-functional stakeholders

Strong communication and governance

Job description

VP Case & Condition Management Programs - Hybrid (PA/NJ/DE)

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Under the direction of the Senior Vice President Medical Management, the Vice President of Case and Condition Management Programs has broad discretion and accountability for the development and implementation of all internal and external case and condition management and population health programs focused on equitable whole-person care inclusive of both behavioral and physical health for members of Independence Blue Cross, AmeriHealth New Jersey and AmeriHealth Administrators (hereinafter collectively Independence) to improve access to well-coordinated, high quality, affordable care. The position collaborates on development and implementation with peers in Product, Marketing, Sales, Actuarial, Underwriting, Data, Analytics, and Informatics, Provider Reimbursement & Contracting, Medical Management, Health Value Optimization, Legal and others as required from time to time. These programs and services must comply with requirements of federal and State statutes and regulations and be approved where necessary by the applicable governing regulatory agencies. The position also collaborates with providers to create an integrated model that achieves best clinical outcomes for members with chronic conditions.

The Vice President of Case and Condition Management Programs will need to be a thought leader working with business executives, to offer competitive programs across the healthcare continuum to engage members and providers to achieve better health outcomes and better cost management. Finally, this role will provide leadership that ensures programs implemented align with corporate strategy, meet business objectives, regulatory requirements, and offer exceptional internal and external member experience and satisfaction.

Specific responsibilities include:

Provides the leadership in development of case and condition management and population health programs and services that align with the IHG strategy, vision, mission, and values.

Collaborates across the company ratings, Marketing, Sales, Provider Reimbursement & Contracting, Actuarial, Underwriting, Data, Analytics, and Informatics, Medical Management, Health Value Optimization, Legal, Government Markets and also with vendors and others as required from time to time to develop, implement, monitor and manage programs and services to meet emerging market demands and improve targeted clinical outcomes such as, HEDIS performance and CMS Stars ratings that align with clinical enhancement strategic initiatives.

Own strategic approach for case and condition management and population health management activities across IHG, vendors, and providers, determining best approach, ensuring coordination, and minimizing duplication while ensuring members are afforded a wide spectrum of asynchronous (e.g. computer based self-help and conversational AI and digital self-service), virtual (e.g. text, chat, telephonic, or audiovisual), and where possible integrated services across Independence, providers and vendors for both physical and behavioral health as well as health-related social needs.

Advances the responsible adoption of AI, advanced analytics, and intelligent automation by identifying innovative use cases and supporting implementation to improve operational efficiency, streamline workflows, enhance decision-making, and deliver high-quality, compliant, member-centered services.

Drives the delivery of case and condition management and population health programs and services that improve member experience, member outcomes, have positive financial return and provide value to customers including competitive performance guarantees.

Partners with providers in value based contracting arrangements to identify and implement case and condition management and population health programs and services that aim to promote integration and synergies to drive improved access, coordination experience as well as quality and financial outcomes.

Oversee the management of the case and condition management associates and vendors to deliver programs and services that improve HEDIS performance, CMS Star ratings, including Medicare Part D medication adherence measures, and support providers in delivering clinical programs.

Oversee the integrated autism services model unit, aligning Customer Service, Utilization Management, Case Management, and Population Health associates to provide coordinated, responsive, person-centered, and family member-centered support.

Ensuring that all areas are meeting all objectives pertaining to quality, compliance, regulations, and productivity. In addition, provide exceptional experience for internal and external customers.

Proactively collaborates and partners with key functional areas to assess ongoing program activities, proposed program enhancements, and support initiatives designed to improve performance of key metrics associated with case and condition management and vendor programs.

Responsible for overseeing the relationships with population health vendors tasked with supporting the care journey for members with chronic conditions.

Provides clinical leadership input to contract negotiations, including the definition of service level agreements and the development and implementation of reimbursement strategies.

Provides advocacy and expertise to government affairs staff, legislators, and regulators on case and condition management and population health activities that address integrated, equitable whole-person care.

Oversee day-to-day operations of case and condition management and population health programs and services, including management of the budget, product implementation, and care management provider and vendor arrangements.

Partners with Sales in finalist meetings and other customer-facing engagements, representing Independence’s case and condition management and population health capabilities, clinical strategy, differentiated value, and commitment to improved quality, outcomes, experience, and affordability.

Represent Independence externally to relevant organizations on key case and condition management matters, such as the BCBSA, Consortium National Accounts – Clinical Leadership Roundtable, and AHIP.

Education and Experience

• Must possess current, active, applicable state license to practice.This license must not be subject to probation, proctoring requirements or other disciplinary action, in each state where the practitioner is licensed, and additional certifications where required, to practice his/her profession and specialty.
• In good standing with Medicare, Medicaid and Federal DEA programs.
• Professional experience of at least 3 years over a large clinical and non-clinical staff with increasing responsibility managing case and condition management related functions.Active unrestricted clinical License not subject to probation of proctoring requirements required.
• Minimum of 10 years of progressive leadership roles in varied case and condition management operations.
• Demonstrated track record as an effective collaborator using a consultative approach to influence others and gain consensus and then lead strategic projects to implement new case and condition management programs.
• Sound knowledge of evaluation, deployment and management of case and condition management and vendor programs.
• Demonstrated leadership skills in planning, measurement, monitoring and performance management with proven ability to develop and execute a business, including a strong track record of delivery success.
• Strong leadership and talent management skills and effective verbal and written communication skills including presentation skills.
• Demonstrable experiences in thinking beyond the current state and into the future, balancing multiple perspectives when setting direction or reaching conclusions.
• Excellent interpersonal skills with internal and external customers.
• Experience in corporate budget, planning, and staff supervision preferred.
• Effective time management skills and the ability to multi-task in a fast-paced environment.

Hybrid

Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.