Resp & Qualifications
PURPOSE:
The incumbent will partner with Actuary, Provider Analytics, and other internal teams to evaluate and monitor the cost of care trends, translate evaluation findings into actionable improvements, and develop solutions that will have a positive impact on the global cost of care for our members and employer groups. This role collaborates cross functionally across the enterprise to provide consulting services and project management and will act as the overall business owner to implement identified cost saving strategies that may span product development, provider payment policies, clinical programs, care management or other operational units.
Note: We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities
ESSENTIAL FUNCTIONS:
- Analyze factors that are driving trend, including cost and utilization. Develop actionable insights and recommendations for value-based interventions based on these evaluations.
- Collaborate with internal stakeholders to identify, prioritize, and develop high impact opportunities for savings that may span product development, provider payment policies, clinical programs, care management or other operational units.
- Develop relationships across the enterprise and collaborate with internal stakeholders to formulate work teams for each identified cost savings strategy. Manages the full project management life cycle for the implementation of each strategy.
- Develop and execute work plans, including project goals and objectives, timelines, resources, and measures of success. Provide verbal and written communications on project status to leadership; make recommendations on project decisions. Coordinate the resolution of resource, budgeting, change, and legal issues. Proactively identify risks and opportunities associated with implementation and develops a mitigation plan.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Public Health, Health Administration, Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years relevant experience.
Preferred Qualifications:
- Masters Degree in Public Health, Health Administration, Business Administration, or related field.
Knowledge, Skills and Abilities (KSAs)
- Consulting skills and/or direct experience in a consulting role
- Experience in a clinical or insurance setting or knowledge in a clinically related field
- Experience working with value-based programs
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $78,984 - $156,871
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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