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Resp & Qualifications

PURPOSE:

This position will play a pivotal role in the modernization and redesign of the utilization management department within the Health Services division. The Sr. Business Consultant provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support initiatives in the changing healthcare industry. Using a deep understanding of utilization management, the Senor Business Consultant acts as a liaison between the UM clinical teams, the technical support teams, and the claims operations teams. Ensures alignment of authorization to claims processing by use of a working knowledge of claims system configuration, including claims edits. The ideal candidate will have a deep understanding of proper plan design across all commercial and government programs plans and experience administering plans in a large payer organization. We are looking for an experienced professional to work remotely. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

Provide subject matter expertise in utilization management workflows and technology platforms as well as project management, finance and budget, data and metrics, information technology, etc., that contributes to the effective accomplishment of initiatives, tasks and goals.

+ Collaborate on the business strategy, thesis, programs and the identification of strategic opportunities. Drive the exploration of opportunities for automation and driving efficiencies for the UM teams.

+ Proactively leads cross-functional teams and projects between divisions, and internal and/or external stakeholders to deliver value to the utilization department and Health Services division.

+ Proactively identify ways, means, and platforms to build synergy and mutually reinforcing workstreams to accomplish tasks more effectively across different business functions of initiatives.

+ Assist in developing, standing up and operationalizing technology platform optimization to track progress, programs, and impact for supported service area.

Design and run dashboards to support clear communication across vertical components of business.

+ Review and support task coordination while identifying potential process improvements.

+ Develop and finalize budgets, policies, and other documentation for programs.

Build trusted relationships within and across CareFirst to deepen subject-matter expertise, find opportunities to synchronize, and ensure close coordination with teams in their areas of responsibility.

+ Identify opportunities for synergies to improve task execution across the organization.

+ Work collaboratively with other support partners within current and upcoming programs.

+ Communicate strategy, programs, and next steps to leadership and key stakeholders.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree 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:** 10 years experience in business development, operational technology support, general business operations and/or consulting experience.

Preferred Qualifications:

+ Deep understanding of utilization management in order to act as a liaison between the UM clinical teams, the technical support teams, and the claims operations teams.Working knowledge of claims system configuration, including claims edits, is needed to ensure alignment of authorization to claims processing.Deep understanding of proper 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 is helpful when exploring opportunities for automation and driving efficiencies for the UM teams. 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.

+ This position must be able to work efficiently and independently to move critical initiatives forward 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.

+ Professional level communication skills and the ability to participate in and lead conversations and meetings will aid the overall success of the department.

Knowledge, Skills and Abilities (KSAs)

+ Understands business goals and priorities.

+ Follows evolving market, industry and consumer trends.

+ Effective communication of complex ideas both verbal and written.

+ Exceptional project management, facilitation and organizational skills.

+ Excellent relationship management skills.

+ Strategic thinker, problem solver, and a collaborator who can drive engagement and discussions.

+ Significant experience with MS Office (Excel, PowerPoint, Word).

+ Strong analytic skills utilizing tools such as Power BI, Excel, etc.

+ 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:** $120,000 - $214,500

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

PeopleSoft/Self Service/Recruiting

Closing Date

Please apply before:

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

\#LI-SS1

REQNUMBER: 21622