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Resp & Qualifications

PURPOSE:

Provides strategic and tactical planning, as well as, knowledge services relating to the implementation of key mandate initiatives, covering a broad range of legislative and regulatory matters including: Federal, BCBSA, Government Programs, State. Provides internal and external liaison functions, workflow, customer service, communications, training, strategic delivery, efficiency, cost reduction and skill development initiatives. 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:

+ Analyzes legislation and regulations as it relates to CareFirst and creates high level compliance requirements.

+ Primary/dedicated Regulatory point of contact for Project Managers who implementation projects.

+ Takes a lead role in various department and divisional projects, to ensure compliance with project compliance requirements, providing input on work team participants, identification of business needs and development of solutions, training, collaboration and communication.

+ Present content, insights and guidance to Mandates and other CareFirst business areas, BCBSA and/or Blues Plans as needed for generating successful knowledge sharing and working relationships.

+ Collaborate with other CareFirst Divisions/Departments and functional areas to help with identification of workflow opportunities driven by projects, operational changes and/or external regulations.

+ Represent Mandates on Corporate and external facing workgroups, legislative, regulatory, and stakeholder bodies work groups, Americas Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association (BCBSA), as needed.

+ Identify opportunities to create more robust processes surrounding new mandate projects to improve the throughput of the department, streamline operations, improve project outcomes and increase strategic alignment of technical delivery with business operations.

+ Leverage strong business acumen to act as a subject matter expert on a variety of Mandate and cross departmental projects, adding strategic perspective to project and problem-solving efforts.

+ Support internal and external policy decisions by providing management with analysis and recommendations on the operational impacts to CareFirst from external mandates.

+ Support the efforts of the Mandates and ePMO team in the creation, quality assurance and refinement of Project Documentation and Status Reporting.

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, Finance or Technology fields.

**Experience:** 10 years' Healthcare operations and/or healthcare regulatory business background. Project management of healthcare related projects may be substituted for some of the years of business experience.

Preferred Qualifications:

+ Advance degree or Certificate in Public Health, Public Policy, Business, Finance or IT fields; or 15+ years progressive healthcare operations and/or healthcare regulatory experience.

+ Experience and exposure to both IT and Business functions in a management position.

+ Strong experience in connecting strategic imperatives to tactical project delivery, in collaboration with senior business and IT executives.

Knowledge, Skills and Abilities (KSAs)

+ Considerable judgment, tact, initiative, accuracy and integrity. Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.

+ Superior analytical skills and understanding of where to find information germane to mandates.

+ Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem.

+ Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

+ Self-motivated with a commitment to teamwork.

+ Ability to recognize, analyze, and solve a variety of problems.

+ Ability to convey information in a clear, concise, and logical manner.

+ In-depth understanding of healthcare payor industry and operational processes and impacts of regulatory guidance.

+ Effective written and interpersonal communication skills.

+ Knowledge of state legislative and regulatory processes, public policy analysis.

+ In-depth understanding of healthcare payor industry and operational processes and impacts of regulatory guidance.

+ Understanding of insurance products and regulatory environment.

+ Proven analytical and problem-solving skills to evaluate business processes and recommend effective solutions.

+ Experience in project management, business process analysis, workflow, and task analysis.

+ Analytical skills and understanding of where to find information germane to mandates.

+ 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:** $124,880 - $223,223

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

Mandates Regulatory Ops and Re

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

\#LI-LJ1

REQNUMBER: 21717