Position Description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

The Population Health Sales Consultant is an internal and external customer facing health care professional who works directly with Health Promotion & Wellness consultants, Sales, Care Management, and employer group customers to implement strategies and interventions to improve member health outcomes. 

This position will lead key population health assessment projects using available analytical tools, consult with customers on population health strategy development and facilitate targeted interventions across the care delivery team to quantitatively improve health outcomes. 

The Consultant works with their assigned customer base in leveraging all available analytical tools, to identify opportunities for clinical intervention, recommend strategies to address the identified opportunities and assist in the identification of optimal clinical support and programming.

The Consultant will serve as a liaison between the customer and the clinical teams available to support their needs.

Additionally, the individual will lead initiatives focused on health promotion and wellness, quality strategy, population health and medical value analysis, and provide data-driven reporting, while maintaining compliance with accreditation and regulatory requirements. The individual will research and employ nationally recognized quality standards and metrics; analyze quality outcomes; and assist with development of data collection.

Responsibilities and Qualifications

• Implement the population health framework for assigned customers and populations of focus to effectively improve overall health and utilization patterns including gaps in care, ED utilization, inpatient admissions and readmissions along with other key metrics for their entire population.
• Develop and maintain effective working relationships by meeting regularly with customers to foster opportunities to improve health and well-being of customer population. Develop and maintain knowledge of current customer contract(s) and performance guarantees. Maintain up-to-date knowledge of the customer’s specific resources, and community resources available to assist in addressing identified needs and opportunities for assigned populations.
• Serve as a liaison between all parties to the population health initiative assigned, to prevent duplication and promote effective management of the assigned population. Refer members to the appropriate programs to meet the member’s needs. This may include internal and external care management and vendor programs.
• Integrate Triple Aim principals to improve member health outcomes and experience of care achieved per dollar spent. Measurably impact member health, experience of care and the delivery of medical value through the relationships, programs and initiatives with hospitals, facilities, providers and provider groups. Identifies and reports quality of care issues in accordance with established departmental policies and procedures.
• Fully leverage all data and reporting tools in performance of duties to include Facets, Trucare, Salesforce, and employer group reporting/HUB.
• Develop and recommend improvement initiatives to support ongoing clinical efforts.

Leadership:

• Ability to work cross functionally, prioritize tasks and possess project management skills.

Knowledge:

• Knowledge of payor industry preferred.
• Knowledge of evidence-based care management and behavioral change models.
• Understands and complies with URAC, NCQA, CMS, ERISA, and all applicable state requirements.

Skills:

• Ability to analyze data and provide clinical insights. 
• Proficiency in Microsoft Excel and Access applications. Ability to learn new vendor tools, i.e. Power BI.
• Ability to conduct research using the internet as directed by management.
• Strong interpersonal communication skills (Written and oral) proven ability to deliver presentations professionally, clearly, and effectively with internal and external audiences both virtually or in-person.
• Demonstrates the ability to develop rapport effectively and maintain strong interpersonal relationships internally and externally.
• Ability to prioritize workload and assignments and perform accurate detailed and timely completion of assigned duties.
• Always maintains Member confidentiality. Shows sound judgment that affirms the rights and responsibilities of members/participants, families, health care professionals and health care organizations.

Experience:

• 5 years' clinical nursing experience required.
• Minimum 2 years' care management experience and or experience working with claims data.
• Clinical analytic experience and proficiency with analytic tools (i.e., Excel, Power BI) required.
• Experience working with self-funded employer groups preferred.
• Experience with presentations of population health clinical programs to large groups preferred.

Education, Certification, and Licenses:

• Registered Nurse with active License. Licensure must be in good standing.
• Certification as CCM or CCP is preferred.
• Bachelor’s degree in health care is strongly preferred.

Travel Requirements:

• Interstate travel may be required based on customer needs.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. 
• The employee must occasionally lift and/or move up to 5 pounds.

Key Interfaces:

• Health Promotion and Wellness, Sales, Care Management, Utilization Management, Population Analytics, Analytics & Reporting

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.