Head of Health Activation & Provider Integration Remote

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

Healthcare decisions are made in momentsâ??when a clinician orders a test, prescribes a medication, or recommends a treatment plan, and when a member decides whether to proceed. These moments determine quality, affordability, and outcomes. Too often, they occur without timely clinical context, care-gap visibility, or cost transparency.

BCBSNE is executing a strategic shift from a reactive, after-the-fact health insurance model to an event-driven, point-of-care health model. This role exists to make that shift real by ensuring the right insight is available at the right moment inside provider workflows and reinforced through timely member engagement.

The Head of Health Activation & Provider Integration creates and owns the Health Activation strategy, and operationalizes clinical and financial insight at moments of truth so providers and members can make better decisions before outcomes and costs are locked in. The role turns enterprise health activation vision into measurable results through partnership, operational leadership, and disciplined execution across the healthcare ecosystem.

What you'll do:

• Lead point-of-care activation across provider workflows, including but not limited to care gaps, prescription affordability, imaging and site-of-care transparency, and authorization status.       
• Drive adoption of workflow-integrated decision support using standards such as CDS Hooks and SMART on FHIR.   
• Operationalize bi-directional data exchange with BCBSA, local provider partners and the State Health Information Exchange (HIE).            
• Recommend and execute a prioritized activation portfolio focused on decisions that materially affect quality, access, and cost.              
• Partner closely with appropriate internal areas and provider partners to ensure member engagement is event-driven and reinforces provider decisions.         
• Co-chair the enterprise Activation Governance Forum with a designated clinical leader; ensure every activation use case has explicit CMO clinical sign-off before production deployment.       
• Measure outcomes and continuously refine activation based on real-world adoption and impact.                 

To be considered for this position, you must have:

• 7+ years of experience in payer, provider, or health information exchange environments leading technical implementations and strategic partnerships is a must.

• Degree in Nursing is desired. Current practicing license not necessary.

• Proven leadership of teams delivering provider integration, interoperability, or clinical workflow solutions. 

• Ability to lead in matrixed organizations through authority, oversight, and influence. 

• Working knowledge of CDS Hooks, SMART on FHIR, and modern interoperability patterns. 

• Comfort leading complex change across clinical, technical, and operational domains. 

Blue Cross and Blue Shield of Nebraska, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process or have questions about the essential job functions of the position, please email Human Resources at Humanresources@nebraskablue.com for further assistance"

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.