Cost Containment and MLR Optimization Program Lead

BlueCross BlueShield of South Carolina

Cost Containment and MLR Optimization Program Lead managing health management programs to assess impacts and develop reporting mechanisms at BlueCross BlueShield of South Carolina.

Posted 6/30/2026full-timeColumbia • South Carolina • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Develops, implements, evaluates, and maintains health management programs
Positions BCBSSC to compete effectively with other companies
Achieves positive return on investment through oversight of new product/technology development and promotion of service enhancement strategies to increase customer retention
Develops and conducts health management presentations to management, internal and external customers that are informative and customized to meet health plan and customer needs
Establishes reporting mechanism that details clinical outcomes, utilization statistics and ROI
Develops and maintains specific reporting to include tracking of efficacy, clinical/financial outcomes, research analysis, and the accuracy/timeliness of data collection
Provides leadership and direction to staff through employee development, management training, and budget oversight
Develops, implements, complies with and promotes staff adherence to corporate and department policies, procedures, and performance and communication standards
Complies with and monitors adherence to URAC case management standards, SC Department of Insurance regulations, SC Nurse Practice Act, all applicable state and federal laws and standards of national accreditation agencies, as management deems necessary

Requirements

What you’ll need

Bachelors in a job-related field
5 years’ clinical or experience developing, implementing and evaluating population health programs with two of the five years in a supervisory role or equivalent military experience in grade E4 or above
Ability to understand and communicate healthcare policy
Working knowledge of word processing, spreadsheet, and presentation software
Ability to work independently, prioritize effectively, and make sound decisions
Demonstrated customer service, organizational, research, and presentation skills
Demonstrated verbal and written communication skills
Analytical, critical thinking, and math skills necessary to collect, analyze, and report data
Highly developed knowledge of planning, programming, and budgeting activities
Ability to persuade, negotiate, or influence others
Ability to handle confidential or sensitive information with discretion
Ability to direct, motivate, and assess performance of others

Benefits

Comp & perks

Subsidized health plans
Dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Data Collection and ReportingProgram EvaluationClinical Research AnalysisHealth Management Program ImplementationStatistical Analysis

Soft Skills

Customer ServiceOrganizational SkillsPresentation SkillsCritical ThinkingDecision Making