Resp & Qualifications
PURPOSE: Provides clinical support and directs daily departmental activities that generally include care management, interpreting medical policy, quality improvement, Healthworx, disease management, utilization review, and medical claims review. Plans and coordinates functions with other departments and interfaces with internal and external customers.
PRINCIPAL ACCOUNTABILITIES: Under the supervision of the CMO
1. Directs daily clinical, operational and administrative activities for CareFirst;
2. Establishes goals, objectives and standards for CareFirst;
3. Interprets and implements policies and procedures to monitor overall efficiency and adherence standards for department for CareFirst;
4. Serves as a liaison with other departments and divisions for development and implementation of programs, products and activities;
5. Liaison to other departments and divisions for interpretation of Medical Affairs policies and practices;
6. Develops and implements programs for education of affiliated providers;
7. Serves as clinical and administrative resource and ensures adherence to policies, procedures and external regulatory agencies.
• Medical Degree from an accredited medical school, completion of an American residency program required with postgraduate training.
• Minimum of 5 years clinical practice experience or equivalent.
• Board Certification
• 2 years managed care experience.
• Current license to practice in Maryland without restriction.
• Excellent organizational skills and communication skills, both verbal and written. Strong interpersonal skills needed.
• Must be able to 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. 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.
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: 2/2/2020
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 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