Blue Cross and Blue Shield of Minnesota

RN Case Manager About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have The RN Case Manager provides telephonic support to members with health needs by conducting assessments, identifying gaps in care, and developing individualized care plans. This role coordinates referrals, connects members to community and in-network providers, and helps members understand their benefits, ensuring comprehensive support without delivering direct clinical care. What You'll Do Provide telephonic engagement only, using motivational interviewing...

Senior Healthcare Contracts Consultant About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position combines the disciplines of contract management, project coordination, and stakeholder engagement. The position offers the opportunity to lead complex contract initiatives, influence business processes, and collaborate with legal, operational, and executive stakeholders across the organization. The successful candidate will serve as a key partner to Underwriting, Legal, Compliance, and business leaders, driving complex contract...

Associate Financial Underwriter About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position is responsible for reviewing, preparing and analyzing risk for renewals, proposals, and benefit changes. The underwriter is responsible for negotiation with sales or account management for final price and product configuration, support, documentation, and communication of the same. What You'll Do Analyzes and evaluates existing and new business standard risk. Provides communication to internal customers on underwriting...

Employee Relations Director About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have The Director Employee Relations (ER) is a handson, working leader responsible for both personally managing complex employee relations matters and leading a team of Employee Relations and Leave of Absence (LOA) professionals. This role provides enterprise operational, governance, and risk leadership for ER execution, translating ER strategy into disciplined daytoday decisionmaking and applying advanced judgment, critical thinking, and risk assessment to...

Associate Account Advisor About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position is responsible for retaining and onboarding less complex clients through service and administration excellence. It collaborates and supports other Account Advisors, Account Managers, and other external stakeholders, (Clients, Agents, Consultants and Brokers) to actively retain existing business. For designated accounts this position provides proactive service directly and timely resolution of service issues by coordinating with peer Account...

Director Clinical Operations - Utilization Management About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have Blue Cross and Blue Shield of Minnesota is hiring a Director, Clinical Operations in Eagan, MN. In this role, you will provide strategic and clinical leadership for Utilization Management (UM), strengthening practices that support high-quality clinical decision-making, operational excellence, affordability, and positive member outcomes. You will build strong internal and external partnerships while advancing performance,...

Case Manager - Behavioral Health About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have Provides telephonic support to members with behavioral health needs by conducting assessments, identifying gaps in care, and developing individualized care plans. This role coordinates referrals, connects members to community and in-network providers, and helps members understand their benefits, ensuring comprehensive support without delivering direct clinical care. What You'll Do Provide telephonic engagement only, using motivational...

Director Major Accounts About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position has accountability for client retention and growth, margin contribution and overall business performance of the National Accounts segments. Develops the segment business plans and oversees reporting of key indicators to ensure business plan objectives are met and we are able to forecast and adjust actions as needed to meet corporate market segment goals. Accountabilities include client and fund business planning and strategy development, and...

Enterprise Resilience Consultant About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have The Enterprise Resilience Consultant will help strengthen the organization's ability to anticipate, prepare for, respond to, and recover from operational disruptions. As part of the Enterprise Resilience Program, this role will partner with business leaders to conduct business impact analysis, develop and maintain continuity plans, facilitate exercises, and identify opportunities to improve organizational resilience. The successful candidate will...

Product Manager About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have Blue Cross and Blue Shield of Minnesota is hiring a Product Manager. In this role, youll support current products within a division and product initiatives and/or new programs and may lead other products. This position supports product planning, iteration and delivery for assigned products within a division or affiliated companies. This role collaborates closely with other departments within Stella to assist in implementing products, ensure ongoing product...

Senior Account Advisor About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position is responsible for retaining clients through service and administration excellence. This position achieves results by having relationships with clients and agents/brokers acting as an advocated within Blue Cross. It collaborates and supports the Account Manager, and other external stakeholders, (Clients, Agents, Consultants and Brokers) to actively grow and retain existing business. This position is responsible for preparing and delivering...

Manager Clinical Enablement About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have In this role, you will be responsible for leading a team that serves as a conduit between the clinical operations teams, product teams and technology to effectively design, develop, implement, and maintain platforms, systems, applications and processes that enable efficient and effective clinical operations. You will be responsible for ensuring that platforms, systems, applications and processes are reliable, effective, and configured to be compliant...

Quality & Risk Adjustment Provider Consultant About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have In this role, you will provide support for providers with value-based agreements. You will review provider-specific data and identifies actionable opportunities for providers to improve their Quality (HEDIS/Stars) and Coding Accuracy/Risk Adjustment performance. You will lead face-to-face meetings with leaders in provider care systems and is responsible for developing and driving improvement via provider-specific action plans. In...

Pharmacy Benefit Manager Operations Analyst About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have As a PBM Operations Analyst, you will focus on establishing and refining operational processes related to CMS and State requirements for Medicare products. In this position, you will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM) departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance. What You'll Do Core...

Program Manager, Risk Adjustment Coding and Quality About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have Blue Cross and Blue Shield of Minnesota is hiring a Program Manager, Risk Adjustment Coding and Quality. In this position, youll be responsible for the design, implementation, evaluation, and ongoing management of the Risk Adjustment Coding and Quality Program, supporting Medicare, Medicaid, ACA, and Commercial populations to optimize Blue Crosss earned risk-adjusted revenue. The role serves as the subject matter expert for risk...

Principal Product Manager - Product Led Model About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have The Principal Product Manager owns the product roadmap across market/product lines which aims to improve business results around revenue growth, cost control/reduction and product gaps. This role is responsible for the design and implementation of new products within existing and new market/product lines. Ensures ongoing product efficiencies that may include product iterations, enhancements, lifecycle planning, product roadmap,...

Network Business & Finance Consultant About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have As a Network Business and Finance Consultant, you will support provider contracting, settlements, reporting, and business analysis activities through data analysis, process execution, and operational support. In this role, you will contribute to the accuracy, compliance, and effectiveness of provider arrangements while developing foundational knowledge of healthcare finance, payment methodologies, forecasting, and business operations....

Senior Internal Auditor About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have In this position, you will plan and direct, as well as provide analytical and operational support for complex internal audit projects, Internal Controls over Financial Reporting (ICOFR) test work, and special projects. You will have significant project and reporting responsibilities. As a Senior Internal Auditor, you will plan, direct, and coordinate several cross-departmental audit projects simultaneously to address foundational and intricate operational...

Vice President Clinical Operations About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have At Blue Cross and Blue Shield of Minnesota, caring for our members and communities shapes how care is coordinated, how teams work together and how members experience healthcare. Reporting to the COO, the Vice President of Clinical Operations will provide strategic leadership and operational oversight for case management, utilization management, and behavioral health across all lines of business. This leader will lead teams supporting both...

Senior Health Plan Accreditation Analyst About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You'll Have This position is responsible for working closely with leadership, leading cross-functional, cross-divisional teams, and partnering with external entities to achieve accreditation readiness, providing in-depth knowledge of accreditation requirements. The incumbent will provide business area consulting, assess organizational processes and policies, gather and annotate documents, provide feedback and evaluate progress, collect data and conduct...