Sr. Program Manager (Case Management)

The Role
The Senior Program Manager serves as the primary operational leader partnering with the clinical and business operation leaders executing on projects, day to day operations and overall vendor management including MHK – Care Management, Optum (Impact Pro), and Point Click Care (ADT).

This role provides project and program management support for internal and external care management initiatives to Health & Medical Management. The primary responsibility is to drive engagement and lead collaboration with Health & Medical Management leaders in strategizing, coordinating, and implementing changes within the Health Management department or their assigned Care Management areas, often serving as the operational lead. Accountable for end-to-end operations management of MHK, Impact Pro, and Point Click Care, including leading release management, troubleshooting issues, and driving system optimization. Additionally, responsible for driving member identification strategic initiatives, collaboration with Digital Care Management leaders, and Medicare Stars to enhance program effectiveness and outcomes.

The Team
As an integral part of the HMM Core Application Team, the Senior Program Manager collaborates with internal and external areas across the company.  The Senior Program Manager also works collaboratively with their peers of analysts, project managers and technical consultants. With a deep understanding of both business and clinical processes, the Senior Program Manager serves as a key liaison, translating operational concerns into actionable insights and advocating for Care Management and clinical teams with vendor partners.

Key Responsibilities:

• Drive operational workflow improvements by analyzing, identifying, and implementing efficiency opportunities.
• Engage and influence senior leadership, external vendors, and consultants to align on strategic priorities and operational goals.
• Spearhead complex programs and projects, ensuring strategic alignment, meticulous planning, and seamless execution.
• Leverage data-driven insights to conduct high-level strategic, qualitative, and quantitative analysis, resolving complex business challenges.
• Develop and execute innovative solutions that enhance program effectiveness, align with market demands, and drive quality improvements.
• Lead large-scale, cross-functional initiatives that drive operational excellence, process optimization, and business transformation.
• Own and oversee assigned programs and vendor relationships, collaborating with clinical leadership to achieve financial, operational, and clinical goals.
• Optimize business processes through system configuration, integration, and performance to drive efficiency and scalability.
• Partner with technical consultants and business leaders to align on strategic objectives and implement both system-based and process-driven solutions.
• Govern care management monthly vendor release cycles, ensuring timely deployment, seamless integration, and proactive issue resolution.
• Facilitate and lead program meetings, setting agendas, documenting key decisions, and driving follow-up actions.
• Manage and prioritize maintenance requests, system enhancements, and defect resolution to support continuous improvement.
• Ensure system stability by proactively monitoring performance, executing configuration updates, and validating fixes.
• Advance member identification strategies, collaborate with Digital Care Management leaders, and drive Medicare Stars initiatives to enhance program effectiveness.

Key Qualifications:

• Experience managing clinical operations, including staffing forecasts, team performance metrics, reporting, and process improvements.
• Proven ability to develop and execute strategic initiatives using both qualitative and quantitative analysis.
• Strong multitasking skills in a fast-paced, dynamic environment.
• Exceptional communication and presentation skills for both large and small audiences.
• Strong interpersonal skills with the ability to engage physicians, nurse reviewers, and administrative leaders at all organizational levels.
• Proven leadership in team building, consensus-building, and stakeholder engagement.

Education and Experience:

• 7+ years of experience in a managed care environment required.
• 7+ years of healthcare leadership experience preferred.
• Demonstrated ability to lead, motivate, and manage direct reports, cross-functional teams, and matrixed relationships.
• Established track record of handling ambiguous, high-stakes projects requiring autonomy and sound decision-making.
• Strong enterprise-wide relationships and ability to influence key stakeholders.
• Bachelor’s degree (BA/BS) in Healthcare, Business, Health Management/Administration, or a related field preferred.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

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The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.