Health Care Manager, Utilization Management

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Compensation and Benefits Package

Overview: Responsible for researching, planning, organizing, directing, implementing, and management of corporate programs and initiatives dedicated to enhancing health care value. The position operates within broad objectives to ensure optimum utilization of manpower and budget. Specialize in research, planning, development, implementation, and leadership.<br /> <p><span style="font-size: small;"><strong>Department Preferences:</strong></span></p> <ul type="disc"> <li> <p><span style="font-family: Arial;">Strong understanding of utilization management</span></p> </li> <li> <p><span style="font-family: Arial;">Strong communication skills are required to understand, interpret and communicate ideas</span></p> </li> <li> <p><span style="font-family: Arial;">Working knowledge of data languages such as SAS or SQL</span></p> </li> <li> <p><span style="font-family: Arial;">Ability to effectively interface with employees at all levels</span></p> </li> <li> <p><span style="font-family: Arial;"><span style="font-size: small;">Understand and apply statistical inference</span></span></p> </li> </ul>
Responsibilities: <ul> <li>Utilize data analytics and extensive business knowledge to manage the research, analysis, identification and evaluation of data from identified problems to evaluate existing and potential trends, competition, and issues.</li> <li>Possess and maintain in-depth knowledge of BCBSM business, products, programs (including claims, reimbursement, benefits, provider and program data, networks, etc.), corporate organizational structure (including functional responsibilities), and complex research principles/methodologies.</li> <li>Lead and monitor multidisciplinary corporate programs/projects simultaneously by managing the establishment of project plans and objectives to ensure goal attainment within defined parameters. Develop solutions to complex issues and present recommendations to senior management as well as employees at various corporate levels.</li> <li>Act as a Health Care Consultant by developing strategies and programs to reduce health care benefit costs and improve quality of care.</li> <li>Collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results.</li> <li>Ensure programs and initiatives encompass broad corporate scope and present significant variables.</li> <li>Anticipate, identify, and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities.</li> <li>Independently develop and plan, reports, papers and/or other materials.</li> <li>May have direct supervisory responsibility which includes performance reviews.</li> <li>Other duties may be assigned.</li> </ul>
Requirements: <ul> <li><span style="font-size: small;">Bachelor's Degree in Business Administration, Economics, Health Care, Information Systems, Statistics or other related field is required. Master's Degree in related field preferred.</span></li> <li><span style="font-size: small;">Seven (7) to Ten (10) years experience of related experience, typically in two (2) subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).</span></li> <li><span style="font-size: small;">Excellent analytical, planning, problem-solving, verbal and written skills to communicate complex ideas.</span></li> <li><span style="font-size: small;">Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</span></li> <li><span style="font-size: small;">Ability to work independently, within a team environment and communicate effectively with employees at all levels.</span></li> <li><span style="font-size: small;">Other related skills and/or abilities may be required to perform this job.</span></li> </ul> <br /> <p><strong><span style="font-family: Arial; font-size: small;">DEPARTMENT JOB SUMMARY</span></strong></p> <ul type="1"> <li> <p><span style="font-family: Arial; font-size: small;">Use WCM databases and tools in combination with claims and membership, for tracking and reporting program results</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Apply predictive models developed by WCM to prepare reports using tools such as SAS, ACCESS, Word, Excel and PowerPoint</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Support Customer reporting commitments using charts, graphics and other presentation techniques</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Apply analytical methodology developed in WCM to design reports that provide savings, ROI and other program effectiveness outcomes to both internal and external customers</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Work with WCMC senior staff to identify, research, analyze, understand and resolve data integrity issues that impact reporting</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Make the most of available tools, methods and data for reporting</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Function independently to initiate research and investigation regarding measurement and reporting issues</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Assist with implementing standard policies and procedures for providing routine reporting and provide recommendations for the ongoing improvement of the updated process</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Develop and maintain an effective working relationship with customers or partners</span></p> <p><span style="font-family: Arial; font-size: small;">&nbsp;</span></p> <p><strong><span style="font-family: Arial; font-size: small;">INTERNAL DESCRIPTION</span></strong></p> <p><span style="font-family: Arial; font-size: small;">&nbsp;</span></p> <p>&nbsp;</p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Responsible for identifying, collecting, analyzing and maintaining data to evaluate issues that support prospective business decisions.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Coordinate projects for senior management.</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Research, analyze, identify and evaluate data from assigned problems to evaluate existing and potential trends and issues.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Possess and maintain a comprehensive understanding and knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Assist in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Recommend, communicate and implement solutions to identified problems/root cause of issues.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Provide expertise and guidance to unit and corporate staff as required.&nbsp;&nbsp;Represent and participate in group or committee discussions.&nbsp;&nbsp;</span></p> </li> <li> <p><span style="font-family: Arial; font-size: small;">Other duties may be assigned.</span></p> </li> </ul>