CareFirst Careers

Clinical Advisor

Resp & Qualifications

PURPOSE: 
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.

PRINCIPAL ACCOUNTABILITIES:
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:

1. 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. 

2. 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.

3. 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.


QUALIFICATION REQUIREMENTS:

Certification/Licensure:

• Must be currently licensed as a Registered Nurse or Licensed Clinical Social Worker.

Experience/Abilities/Skills/Knowledge:
• 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.


Preferred:
• 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


#LI-TV1

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: 5/30/2020

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.

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

Learn more about Medical Management