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Resp & Qualifications

PURPOSE:

This position will support the modernization and redesign of the utilization management department through thoughtful contributions to process analysis, mapping, and managing process improvements made in alignment with goals for the department and organization. Supports the analysis and evaluation of business problems and the development of solutions to address identified problems, using deep understanding of the utilization management function and workflows. Provides a single point of contact for those projects. Takes projects from original concept through final implementation. Assignments typically include problem definition, evaluation of requirements, and facilitation of the implementation of systems and/or process to meet business and user requirements. We are looking for an experienced professional to work remotely from within the greater Baltimore 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:

+ Analyzes business processes and coordinates with technical (IT) teams to analyze technical and clinical processes and resolve problems. This includes coordination and input to formulate and develop new and modified business platforms and workflows that results in automation and driving efficiencies for the UM teams.

+ Interfaces with all areas affected by the project including clinical and non-clinical end users, computer services, and other key stakeholders.

+ Represents the UM department to define requirements and business cases for the technology developments.

+ Identify current processes and potential changes to ensure increased operational efficiencies and productivity improvements for the UM staff and related internal clinical partners.

+ Conduct process analysis activities to include interviewing, observing, and timing of operational tasks for current state and future state. Map individual task workflow; create and maintain workflow charts for all major tasks; update and validate models, service agreements and cost benefit documentation.

SUPERVISORY RESPONSIBILITY:

Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree in Business Administration, Business Management 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.

Licenses/Certifications Preferred:

+ Certified in Business Analysis -PMI

**Experience:** 5 years operational analysis experience or 2 years as a Business Process Analyst.

Preferred Qualifications:

+ Deep understanding of utilization management to drive efficiencies and best practice for UM teams. Working knowledge of CareFirst structure and business areas to support the change process from beginning to end.Understanding of plan design across all commercial and government programs plans and experience administering plans in a large payer organization is helpful.

+ Overall technical knowledge and understanding of Guiding Care, Facets, and other key systems as well as how to navigate through compliance requirements is helpful.Ability to work across multiple business areas, collaborate with peers, clinical, clinical support, medical director, and other levels while ensuring alignment with department and organizational goals is crucial to be successful.

+ Must be able to work efficiently and independently and as part of a team to support critical initiatives in alignment with direction established through thought partnership with the Director of UM and the VP/CMO of Medical Management.Ability to use proper change management principles is important as this role will be involved in changes made to the clinical and clinical support operations and processes.

Knowledge, Skills and Abilities (KSAs)

+ Skill in analyzing and organizing technical data.

+ Proficient in Microsoft Office programs.

+ Excellent communication skills both written and verbal.

+ Self starter and ability to collaborate with associates of various levels.

+ 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:** $65,880 - $130,845

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 responsibilities 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

Clinical Utilization Management

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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REQNUMBER: 21623