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Job Description
Healthy Blue Care Together (HBCT) is partnering with the North Carolina Department of Health and Human Services to operationalize the Children and Families Specialty Plan (CFSP). CFSP is a single, statewide Medicaid Plan designed to provide seamless, integrated, and coordinated care to enrolled infants, children, youth, young adults, and families served and previously served by the child welfare system. HBCT is outcomes-driven and focused on ensuring that all members have access to quality services and benefits across North Carolina, addressing their physical health, behavioral health, pharmacy, intellectual/developmental, long-term services and supports, unmet health-related resource, and care management needs.
The Principal Business Operations Advisor (OA), in collaboration with Plan-level leadership and support staff, will oversee monitoring and evaluation of key aspects of HBCT Plan execution, focusing on: Plan-based and delegated staffing and performance; clinical, care management, medication monitoring, psychosocial, and specialty program implementation; and provider network and service access equity and quality. The OA will lead the development of data management and reporting strategies aligned with our Continuous Quality Improvement framework and Monitoring and Evaluation plan. The OA will collaborate with the Outcomes Monitoring and Evaluation Team to support population- and member-level outcomes monitoring and evaluation.
What You'll Do Business and Strategic Planning
Develop and implement Continuous Quality Improvement framework and Monitoring and Evaluation plan. Build andfacilitaterepeatable andPlan-focused strategic planning processes that include confirmation of continued relevance, progressevaluationand communication to affected stakeholders. Advise and communicatewithPlanleadershipand externalstakeholders, including senior leadership,regardingprograms,projects,initiatives, emergingissuesand challengeswithinthechild welfaresystems. Developand usekey improvement metrics, such asdashboards, team reporting, regulatoryreportsand scorecardstoreview programdata and results in comparison with benchmark metrics and expected outcomes. Monitor and evaluate delegatedstafffunctionsactivitiesfor compliance and effectiveness. Proposesa variety of solutions to business issues/problemsutilizing appropriate analysistools (ieCost/Benefit Analysis, Flowcharting,etc). Lead the developmentofaMonitoring and Evaluation Plan, focusedonPlan execution andachievementofobjectivesandgoals. Lead the coordination,planning,and facilitation of variousPlan-levelmonitoring and evaluationworkgroupsto make them more effective,data-driven,and outcomes based. Lead monitoring and evaluation strategy development and activitiesaddressingstaffing, staff to member rations,and staff performance Support development ofbusiness plans and analysis under guidance fromPlanleadership. Facilitate the adoption ofCQI-drivenPlanoperating procedures and processes for thePlanandassistwith the communicationtoand educationof externalstakeholders and delegated partners. Provide input and recommendedstrategyforPlanleadership'spublic speaking engagements and/orBoard or committee meetings. Facilitate change management work to support business and process improvements and overallPlaneffectiveness.
Project/Initiative Management
Lead and coordinate work for special projects or initiatives for the Plan as assigned. Possible duties could include: Evaluation of potential opportunities and recommendations to reduce costs/improve efficiencies Review and evaluation of best or next practice opportunities for potential adoption Develop recommendations based on important industry literature and ensure leadership is briefed on current and emerging issues of importance to the organization. Serve as lead on engagements with external entities (i.e. consultants, external stakeholders, delegated partners) and coordinate data gathering and research efforts based on the direction of Plan leadership. Manage tracking of initiatives/projects for the division and independently create presentations of initiative/project progress for varied audiences, which may include Senior Plan Leadership. Data Analysis/Reporting
Lead the consolidation and standardization of data analysis and reporting for relevant Plan operations. Provide analysis and insights for proposed strategic initiatives by leveraging a unique perspective on the end-to-end operations of the Plan. Support Plan budget analysis, provide input into and monitor budget forecasts, and review progress against administrative cost reduction goals Track and evaluate goal progress, including data collection and analysis of key performance metrics (KPIs). What You Bring
Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field.
Bonus Points
Continuous quality improvement experience within a Managed Care Organization Experience with Child Welfare systems, data analytics, KPIs, and metrics Expert in excel, tableau and/or other data management tools Experience in working in a matrixed environment, facilitating work across multiple teams and priorities
The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $118,691.00 - $189,906.00
Skills
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Blue Cross and Blue Shield of North Carolina
$118,691.00 - $189,906.00
parental leave, paid time off, tuition reimbursement, 401(k)
Feb 04, 2026