CareFirst Careers

Specialty Practice Consultant, Patient-Centered Medical Home

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Resp & Qualifications

GENERAL SUMMARY:
CareFirst is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 4,500 associates and more than $8 billion in annual revenue.  The company is regarded as a top employer in many surveys and offers competitive salary and benefits. 

About CareFirst’s Patient Centered Medical Home (PCMH) Program:
Much different from other such programs, CareFirst launched its Patient-Centered Medical Home (PCMH) Program in 2011 and currently has more than 4,000 participating primary care providers organized into over 400 Panels.  Nearly $5 billion in global health care cost is managed by the Program on an annual basis.  With 7 full performance years complete, the Program has produced savings (actual cost vs. expected cost) every year.
The PCMH Program Consulting team consists of more than 30 individuals with varying educational and work backgrounds.  We have individuals who hold MPHs, MBAs, MHAs, and MPAs from a variety of leading universities.  Successful candidates come to CareFirst from provider organizations, business, government, advocacy organizations and other payers.
Given CareFirst’s presence in the region, the sophistication of the PCMH model and the substantial experience gained since 2011, this is the best opportunity in the market for individuals seeking to pioneer the development of the population health management field.

THE IMPACT OF SPECIALISTS AND THEIR VARIATIONS IN COSTS:
The proportion of costs in the health care system driven by Specialists is material, accounting for more than 90% of combined medical and drug expenditures. Costs associated with care provided by these Specialists extends beyond their professional fees having a downstream effect on global health care cost.
CareFirst organizes claims data into “episodes” using sophisticated third-party analytic software.  This enables comparison of like episodes managed among Providers in the same specialty.  The results of this analysis enable Primary Care Providers to understand the cost implications of their referral decisions. 
Among like “episodes” managed by Specialists, the cost can vary as much as 150%.  An individual Specialist’s practice patterns have a significant impact on the total cost of care without any discernible difference in quality. 
Where the Patient receives care (inpatient, outpatient, ambulatory surgery center, office), how frequently care is received (frequency of visit, volume of tests ordered) and drugs prescribed (brand versus generic and specialty drugs) – much of which is in the direct control of the Specialist – impacts the costs associated with managing these illnesses and/or procedures.
In the last three years, CareFirst processed over 180 million claims into 5.2 million episodes of care managed by 8,500 Specialists across 33 Specialties.

ROLE OF THE SPECIALIST PRACTICE CONSULTANT:
The Specialist Practice Consultant works with specialists to review and baseline their performance relative to their peers.  The Specialist Practice Consultant identifies potential changes to the Specialists’ practice patterns which would result in decreasing the overall cost of an episode of care.  Daily responsibilities include the following:

  • Meet with physicians and leadership of large Specialty practices to review Specialist Cost Ranking Methodology and individual Provider Cost Analysis Reports
  • Ensure Specialists and practice leadership understand their impact on the downstream effects on health care costs
  • Influence changes in practice patterns such as:
    • Shifting procedures to lower cost settings (i.e., ambulatory surgery centers, non-regulated facilities)
    • Ordering/performing labs and radiology at cost-effective settings
    • Reducing the volume of unnecessary office visits
    • Assisting in identifying best practices directly related to the specialty
    • Bridge relationships between Primary Care Providers and Specialists including development of Clinical Compacts


In addition, the Specialist Practice Consultant will act as a subject matter expert for the PCMH Team. This will require in depth knowledge of the Specialist methodology, episode data and practice patterns of the top Specialties as defined by CareFirst. 

PRINCIPAL ACCOUNTABILITIES:
Under the general supervision of the Manager, Specialty Practice Consulting, the incumbent’s accountabilities include, but will not be limited to, the following:

1. Build relationships with leadership of key Specialist practices in CareFirst service area and position them to receive referrals from PCMH PCPs by assuring they have appropriate access and collaborate with PCPs effectively resulting in high levels of satisfaction among PCPs, patients and Specialists.  Collaborate with appropriate practice leadership to minimize variability in cost effectiveness by bringing high cost specialists into alignment with more cost-effective peers.

2. Connect PCPs with Specialty practices to direct referral volume. Assist with the organization and execution of Clinical Compacts in defined catchment areas throughout Maryland, Washington D.C., and Northern Virginia.

3. Meet with leadership and Specialists of hospital systems and large Specialty practices in the CareFirst service area to educate on utilization trends and areas of opportunity where their practices or Providers may be outliers when compared to peers.  Assist in the development of internal strategies for reducing the average cost of episodes.

4. Understand the market demand for top Specialties in the CareFirst service area, beginning with Specialties which account for the greatest cost in the system.

5. Active Participant in Corporate Meetings, Practice Consultant Team Activities and Administrative Functions.


QUALIFICATION REQUIREMENTS:
Required Experience/Skills/Abilities:

  • Master’s Degree in Public Health, Health Administration, Business Administration, or related field or equivalent work experience
  • At least 1-3 years of experience in the healthcare field with a specialty practice
  • Experience to quality measurement programs
  • Demonstrated ability to effectively comprehend complex data analysis
  • Solution development
  • Executive presentation skills
  • Effective written and interpersonal communication skills
  • Must be able to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality awareness
  • Well organized, able to multi-task and exhibit flexibility
  • Proven analytical and problem-solving skills
  • Ability to work in a matrixed organization, promoting collaboration and teamwork
  • Effective at building relationships with various levels of business professionals and/or clinicians
  • Drive to establish new relationships within healthcare provider community and be creative in coordinating meetings, overcoming obstacles to scheduling, etc.
  • Strong computer skills including Microsoft Excel, PowerPoint, Word, and Outlook
  • Able to travel through the CareFirst service area as needed
  • While primarily based in CareFirst’s Baltimore Office (Canton), 50% of role is in the field
  • Must have reliable transportation for travel between Corporate offices, provider offices and other locations as needed
  • 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
  • Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time 
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence


Preferred:

  • Experience managing or working within specialty medicine practices or health care systems
  • General understanding of operations, finance, health care systems
  • Consulting skills and/or direct experience in a consulting role
  • Experience in a clinical setting or knowledge in a clinically related field specifically to coding and billing
  • Project management experience
  • Experience using a client relationship management system

Department

Department: Patient-Centered Medical Home Program Consultants

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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 4/19/2018

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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