Resp & Qualifications
The Sales & Affordability Strategy team, serves as a consultative support team within Health Services dedicated to Commercial accounts, Client Advisory Services and the account management team. The team is comprised of clinical professionals and healthcare strategists who specialize in data analysis, healthcare analytics and population health management. This team along with Client Advisory Services proactively reviews all aspects of the account data to provide strategic subject matter expertise, analysis and recommendations on benefit programs, health risk management and health and wellness services. This consultative team of medical professionals and business analysts will present information, observations and recommendations to support the account’s future benefits decision-making. The team will also provide insight and ongoing monitoring to evaluate and validate recommendations implemented. This team outlines strategic action to improve the cost trend and mitigate health risks, while making recommendations on specific initiatives to engage the highest cost, highest risk members.
Through monthly, quarterly and annual meetings, this consultative team will use proprietary data to provide insight into account’s costs, utilization and risk. This analysis will highlight the costliest members, the impact of CareFirst’s programs and the outcomes of member engagement, or lack of engagement, on a period-to-period time comparison.
Furthermore, the consultative team along with wellness consultants, will emphasize opportunities to implement CareFirst’s Health and Wellness programs to identify potential future high-risk members. CareFirst’s Health Assessment, Biometric and extensive coaching programs are a vital component to a complete health benefits offering.
The Clinical Advisor’s primary responsibility is to educate clients, brokers, consultants and internal associates and articulate the value of CareFirst’s approach to managing care delivery to the marketplace. The incumbent will review client-specific data/reporting and in partnership with the Client Advisors and Wellness Consultants, make recommendations to help clients (employer groups) meet their corporate goals and key initiatives relating to the health and welfare of their employee population. The Clinical Advisor serves as a key subject matter expert and strategic partner for the Commercial Sales organization and will regularly attend client meetings (with benefits managers and C-suite executives) to review health outcomes and cost information. This position reports to the Medical Director, Sales & Affordability Strategy and will be responsible for advancing and growing our Commercial Sales business by articulating the value of CareFirst through data and strategic messaging as well as bring the voice of the marketplace back to CareFirst.
Under the general direction of the Medical Director of Sales & Affordability Strategy, the incumbent’s responsibilities include, but are not limited to, providing clinical analysis and subject matter expertise as follows:
Expert at reviewing and presenting population health information, ability to investigate large employers’ high cost utilizers as well as key cost drivers from a clinical perspective; Ability to communicate the value CareFirst offers, ability to communicate CareFirst’s population 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 care support programs. The incumbent will make strategic recommendations to large employer accounts with the goal of improving health quality outcomes and controlling costs for their employee populations. Coordination with Commercial Sales account management teams, Health Services team, Client Advisors, CareFirst Wellness consultants, Marketing & Government Affairs, will be required to ensure productive and impactful employer, consultant and broker meetings are conducted.
Monitors the status of high cost claimants through the member information. 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, Patient Centered Medical Home (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 or LCSW
• Minimum of 4+ years’ experience working as a Registered Nurse or Licensed Clinical Social Worker 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.
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: 1/18/2019
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