Blue Cross Blue Shield of Vermont

Integrated Health Manager, Quality and Operations | Full Time

Category: Insurance


Blue Cross and Blue Shield of Vermont is seeking a Clinical Manager to lead the quality and operations of our integrated health services, ensuring that our case management team can holistically support members with physical, psychological, social and barriers to care. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision,401K, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.

Remote Work: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week. Qualified candidates who are able to be onsite once a week on Wednesdays preferred.

Quality and Operations Manager, Integrated Health Responsibilities

  • Design, refine and manage workflows, processes and procedures for integrated health services that demonstrate measurable value to members and employers and contribute to advancing BCBSVT’s strategic goals.
  • Define and communicate metrics, targets, and reporting mechanisms to create meaningful feedback loops for the integrated health team.
  • Assume lead responsibility for complex case management accreditation and ensure our policies and practices align with NCQA, federal, state, and internal standards.
  • Develop, implement and evaluate a sustainable on-boarding and continuous learning model for the IH department to ensure staff can use all processes, systems and applications to improve member care.

Quality and Operations Manager, Integrated Case Management Qualifications

  • Bachelor’s degree in healthcare or related field equivalent; graduate degree in related field preferred.
  • Active Vermont licensure as RN (with ability to apply for Compact License or active multi-state licensure) , LICSW or equivalent.
  • Minimum 5 years of varied clinical practice experience required with a minimum of 2 – 4 years of case management experience.
  • Experience with NCQA standards and practice of quality improvement.
  • Commission on Case Management (CCM) Certification or willingness to obtain within 12 – 18 months of start date and/or Certified Professional in Healthcare Quality (CPHQ)
  • 5 + years of management experience in a health care context in clinical operations, quality and/or learning and instructional management roles; health plan experience preferred.
  • Willingness to travel as requested.

Program Manager, Integrated Case Management Benefits

  • Health insurance (including vision)
  • Dental coverage (free to employees)
  • Wellness Program
  • 401(k) with employer match + automatic employer contribution
  • Life Insurance
  • Disability Insurance
  • Combined time off (CTO) – 20 days per year + 10 paid holidays
  • Tuition Reimbursement
  • Student Loan Repayment
  • Dependent Caregiver Benefits


To Apply: