Resp & Qualifications
Under the general direction of the Director of Client Advisory Services the incumbent’s responsibilities include, but are not limited to, providing clinical analysis and subject matter expertise as follows:
Expert at presenting SearchLight/HealthCheck information, ability to investigate Large Group employers’ high cost employees as well as key cost drivers from a clinical perspective, ability to communicate the value of both the basic and enhanced value CareFirst offers, ability to communicate CareFirst’s populations health model through the use of data as well as from the member perspective. Meets face-to-face with clients, consultants and brokers to message the value of CareFirst and CareFirst’s clinical programs (PCMH and TCCI). The incumbent will make strategic recommendations to Large Group employer accounts about how to best control cost and improve quality for their employee populations. Coordination with Sales account management teams, CareFirst Wellness consultants, Strategic Marketing, Operations and Medical Management Division will be required to ensure productive and impactful employer, consultant and broker meetings are conducted.
Monitors the status of Large Group High Cost Claimants through the member information in iCentric. Reports this data to the Client Advisors, Sales Account Executive and/or Manager, as requested.
Maintains strict HIPAA guidelines to ensure that members’ PHI is kept confidential and protected.
Works in collaboration with the Client Advisory Services Team to develop business case studies and next generation reports to demonstrate the value of CareFirst care management and wellness approaches. The purpose will be to make strategic recommendations for key accounts and their consultants/brokers in order to retain and grow CareFirst’s business. The goal is to have the marketplace see CareFirst as a healthcare delivery manager and not just an insurance administrator.
Represents the voice of the marketplace as the subject matter expert when working with the staff in other medical, clinical, and clinically-related areas (e.g., Case Management, PCMH, Disease Management, Pharmacy, Behavioral Health) for purposes of contributing to program updates, data analysis and the exchange of information related to account and sales presentations.
• Must be currently licensed as an RN
• Minimum of 4+ years’ experience working as an RN in the medical field
• Demonstrated experience with healthcare data analysis
• Ability to present in front of both small and large audiences
• An in-depth knowledge of current and emerging trends in care management;
• Ability to work closely with and influence people at all levels, including C-suite executives, vice presidents, directors, managers and associates;
• Critical thinking and judgment
• Demonstrated ability to analyze and interpret data;
• Ability to lead/coordinate projects and act as a resource to other CareFirst departments;
• Ability to communicate effectively, both verbally and in writing; and
• Ability to present and communicate in group settings in a professional manner.
• Related undergraduate (BA/BS) or graduate degree such as MSN, MBA, MPH
• Knowledge of health plan sales or account management
• Experience working in a health plan environment in a business role
Department: Clinical Advisors DC
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
Please apply before: 2/22/2019
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.
The physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position, successfully. Requirements may be modified to accommodate individuals with disabilities.
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 employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted. Frequent driving is required.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship