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  • 500 Exchange Street, Providence, RI, USA
    Req #1277
    Thursday, July 22, 2021
    JOB SUMMARY: Serve as an advocate for current and prospective members at retail locations to uphold our vision statement of passionately leading a state of health and well-being across Rhode Island. Simplify health insurance by educating members on their benefits and resolving inquiries. Clarify and resolve account related questions for all lines of business. Provide an excellent customer experience by ensuring that all transactions and inquiries are addressed accurately and in a timely fashi ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1278
    Thursday, July 22, 2021
    JOB SUMMARY: Responsible for leading the day-to-day management of multiple internal strategy consulting engagements simultaneously. Focuses on high-complexity, high-impact strategic and operational business priorities of our executive team, including enterprise strategy and projects for senior divisional stakeholders. Implement the evaluation and planning of strategic initiatives and capital investments, including corporate development activities. Oversee aspects of strategy implementation, ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1280
    Monday, July 19, 2021
    JOB SUMMARY: Want to help us create a great member experience when our members call us? Do you want work on a cloud-based contact center technology? Looking to help call center agents be happier through integrating data and applications into their workflow? We are looking for someone to help prioritize a  roadmap of capabilities across our 15 different call centers, for a total of approximately 500 agents. Identify customer needs, desires, and value perceptions. Maintain a strong partnershi ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1276
    Wednesday, July 14, 2021
    JOB SUMMARY: Support achievement of our strategic objectives and metrics through management of one or more distinct portfolios of investment as approved by the Board of Directors. Manage the successful execution of selected projects in collaboration with the portfolio owner. Develop and maintain an overall schedule for the portfolio which outlines key milestones and identification of dependencies or risks as well as mitigation strategies for issues that jeopardize delivery. Create and overse ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1274
    Tuesday, July 13, 2021
    JOB SUMMARY: Identify market opportunities, evaluate product concepts and lead product development initiatives from concept to design, launch and implementation. Lead the design, development, and reporting of critical business performance measures across the organization’s product and services portfolio. Work across government program segment to develop internal, competitive, and industry insights that drive innovative opportunities to enhance and grow customer and business performance within ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1271
    Monday, July 12, 2021
    JOB SUMMARY: Support the Shared Services team and contribute to the day-to-day operations and advancement of initiatives associated with Salesforce. Assist with the Salesforce initiative rollout and customization, driving continuous improvement into the platform, and establishing best practices to help the business grow. Act as a first-in-line resource to the Sales and Marketing organization in helping utilize the Salesforce platform to drive business results. Deliver deep insights and r ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1275
    Friday, July 9, 2021
    JOB SUMMARY: Represent the company in the sales, service and retention of Dual (Medicare/Medicare) eligible products; meet territory and monthly quotas.  Ensure compliance in all aspects of sales activities. ESSENTIAL JOB FUNCTIONS: Conduct enrollment meetings and health fairs to promote Dual offerings to individuals.  Meet or exceed enrollment goals within the market. Complete all administrative components and manage activities and events within budgets.Seek out local marketing events and sa ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1272
    Friday, July 2, 2021
    JOB SUMMARY:  Assist members in navigating the behavioral healthcare system, ensuring access to evidence-based care. Educate, empower, and coordinate services for members to improve their health and well-being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care. ESSENTIAL JOB FUNCTIONS: Manage members through the behavioral healthcare delivery system; assess needs in order to identify appropriate interventions. Con ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1270
    Wednesday, June 30, 2021
    JOB SUMMARY:  Act as an expert on Medicare/Medicaid clinical pharmacy issues as part of an interdisciplinary care team. Provide support to pharmacy program management and case management to assist in the development and maintenance of high quality, cost-effective pharmacy programs and care plans. Respond to internal questions concerning plan coverage and policies for specific pharmaceuticals, research appropriateness of drug therapies, and provide feedback on state regulatory and legislative is ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1234
    Wednesday, June 23, 2021
    JOB SUMMARY: Act as a key member of the consultative account team for key BCBSRI employer clients. Analyze data to form insighst and be a consultative partner to the Account Executive and account directly to develop recommendations and solutions based on data findings. Present findings to clients directly and serve as a main point of contact for account-specific analytics. Serve in a highly visible role that works cross-functionally across the BCBSRI organization and directly with key acco ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1263
    Friday, June 11, 2021
    JOB SUMMARY: Serve as the team’s expert in community-based resources and assist the beneficiary and/or caregiver in working towards goals related to accessing community services and applying for additional programs and benefits. Assess the beneficiary’s home environment as needed.  ESSENTIAL JOB FUNCTIONS: Conduct assessments, which include identification of member’s internal and social-familial strengths and coping strategies.  Develop, implement and monitor individualized care plans.  Prov ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1265
    Thursday, June 10, 2021
    JOB SUMMARY:Assist members in navigating the health care system, ensuring access to evidenced based care.  Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.  ESSENTIAL JOB FUNCTIONS:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions.  Conduct telephonic or face ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1259
    Thursday, June 10, 2021
    JOB SUMMARY: Provide specialized support to clinical staff by responding to member phone calls; facilitate problem resolution and triage calls to appropriate resource.  Provide administrative and project support to the department and/or management. ESSENTIAL JOB FUNCTIONS:Respond to inquiries from internal and external customers; facilitate problem resolution through research.  Refer call to appropriate resources in a timely manner. Interact with clinical staff to obtain health care information ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1261
    Thursday, June 10, 2021
    JOB SUMMARY: Provide specialized support to clinical staff by responding to member phone calls; facilitate problem resolution and triage calls to appropriate resource.  Provide administrative and project support to the department and/or management. ESSENTIAL JOB FUNCTIONS:Respond to inquiries from internal and external customers; facilitate problem resolution through research.  Refer call to appropriate resources in a timely manner. Interact with clinical staff to obtain health care information ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1262
    Thursday, June 10, 2021
    JOB SUMMARY:Assist members in navigating the health care system, ensuring access to evidenced based care.  Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.  ESSENTIAL JOB FUNCTIONS:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions.  Conduct telephonic or face ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1264
    Thursday, June 10, 2021
    JOB SUMMARY:  Support the activities of the RN and BH Care Managers. Responsible for strengthening the level of engagement with the beneficiary, partnering on SMART goals, facilitating completion of health risk assessments telephonically and/or in person, coordinating needed services for beneficiaries with providers, caregivers and community supports, and communicating with all members of the ICT.  Serve as the liaison to the Concierge (customer service) team to ensure the member understands be ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1257
    Wednesday, June 9, 2021
    JOB SUMMARY:Direct the development and administration of care management and disease management programs, ensuring the delivery of services aligns with industry standards, best practices, and the organization’s care model strategy. Oversee teams responsible for assisting members in navigating the health care system, ensuring access to evidence based care.  Collaborate with senior leaders to create and enhance programs that improve quality of care, enhance the member experience, and reflect cost ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1251
    Tuesday, June 8, 2021
    JOB SUMMARY: Identify quality issues through analysis of data and evaluation of clinical or business processes.  Facilitate the design, implementation, and maintenance of quality initiatives that improve operational business processes or member healthcare and safety.  ESSENTIAL JOB FUNCTIONS: Identify clinical quality issues and business process improvement activities through the analysis of data and evaluation of internal processes.  Conduct analyses to determine root cause and d ... More
  • 500 Exchange Street, Providence, RI, USA
    Req #1254
    Thursday, June 3, 2021
    JOB SUMMARY: Research, write, edit, and translate copy in English and Spanish for corporate/brand publications, marketing campaigns, member communications, and online channels for the Spanish audience.  Ensure adherence to brand, editorial and diversity and inclusion standards, and that marketing messages are culturally appropriate and in line with the organization’s strategic direction.  Collaborate with internal areas to oversee and complete writing projects. ESSENTIAL JOB FUNCTIONS: ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1240
    Monday, May 24, 2021
    JOB SUMMARY:Manage daily operations of the team. Manage the development, implementation, and maintenance of departmental policies, procedures and programs.  Ensure the delivery of case management services are aligned with industry standards, best practices, and the company’s strategy. Monitor industry trends to ensure case management programs are innovative and designed to meet the company’s goals. ESSENTIAL JOB FUNCTIONS:Manage case management programs to ensure the delivery of services is alig ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1247
    Thursday, May 20, 2021
    JOB SUMMARY: Direct and oversee the employer segment strategy, product development & management and sales enablement functions for the organization. Direct the creation and management of product across the employer market segment using data insights, market analytics, and research to create multi-year membership and financial performance models. Oversee the creation and management of product portfolios aligned with strategic objectives, market segment priorities, and business performance ob ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1243
    Wednesday, May 19, 2021
    JOB SUMMARY: Oversee and direct Medicare sales distribution strategy and execution across various channels, including inside/outside sales, broker, retail (sales process) and exchanges. Direct the development and attainment of Medicare sales objectives for membership growth and retention. Oversee broker distribution channel strategy to ensure achievement of sales goals. Monitor operational statistics, performance metrics, oversee audit processes, and assist in the preparation of capital ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1232
    Wednesday, May 5, 2021
    JOB SUMMARY:Provide specialized support to clinical staff by responding to member phone calls and case management requests.  Outreach to members to determine if the member has any specific needs or after gaps in care have been identified.  Enroll members into health management programs utilizing engagement skills and motivational interviewing techniques.  Conduct assessments, monitor, and implement personal lifestyle plans with the member, the member’s family, and health care providers in a holi ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1236
    Wednesday, May 5, 2021
    JOB SUMMARY: Provide leadership, technical expertise, and motivation in reshaping the healthcare delivery system to achieve efficiency, quality, and affordability of healthcare services. Provide leadership in thought, change management, and professional relations, to enhance and maintain relationships with physicians through Provider Profiling, Utilization Review Activities, and Quality Activities.  Ensure organization is compliant with federal, state, and local laws, along with accreditation s ... More
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1219
    Monday, April 5, 2021
    JOB SUMMARY: Negotiate, implement and manage complex contracts with healthcare providers and vendors.  Work to achieve the organization’s financial and business objectives, impacting network quality and trends via thoughtfully structured contractual relationships.   ESSENTIAL JOB FUNCTIONS: Deliver a broad, quality focused, stable and high-performing network to support the BCBSRI customer base.Develop and execute negotiation strategies that directly impact financial and quality performance o ... More