Resp & Qualifications
This position will sit in the Washington, DC office. Requires travel to Baltimore for initial training period for new hires. Position requires travel throughout DMV.
CareFirst has established the Client Advisory Services team, a consultative support team dedicated to Large Group accounts and the Account Management team. The Client Advisory Services team is comprised of clinical professionals and healthcare strategists who specialize in data analysis, healthcare analytics and population health management. This team proactively reviews all aspects of the account data to provide strategic subject matter expertise, analysis and recommendations on benefits 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 Account SearchLight and Healthcheck reports 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 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 serves as a critical member of the Client Advisory Services team. 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 (Large Group customers) meet their corporate goals and key initiatives relating to the health and welfare of their employee population. The Clinical Advisor serves as key subject matter expert and strategic partner for the Large Group 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 Director of Client Advisory Services and will be responsible for advancing and growing our Large Group 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 Director of Client Advisory Services the incumbent’s responsibilities include, but are not limited to, providing clinical analysis and subject matter expertise as follows:
SUPERVISORY RESPONSIBILITY: The position does not have direct reports. The position does require the ability to work in a matrix management environment.
SCOPE: This position involves a high level of client interaction in a consulting role. As a critical component of the company’s large/national account strategy, the Clinical Advisor will be accountable for utilizing health care information tools to explain claims data and trends to our clients in order to appropriately message the value of CareFirst in the marketplace. Key measures of success will include the retention and expansion of CareFirst’s existing employer group accounts, awareness, understanding and appreciation of both the basic and enhanced value CareFirst offers, and improved client satisfaction as evidenced by client surveys. This position must be able to work in a matrix management environment with functional areas of the organization (Sales, Data Informatics, and Medical).
• Must be currently licensed as a Registered Nurse or Licensed Clinical Social Worker.
• Minimum of 4+ years’ experience working as clinical from one of the disciplines listed above 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.
• 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.
• Related undergraduate (BA/BS) or graduate degree such as MSN, MBA, MPH
• Experience in behavioral health field strongly preferred
• 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: 4/1/2020
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