Resp & Qualifications
CareFirst is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 5,000 associates and more than $8 billion in annual revenue. The company is regarded as a top employer in many surveys and offers competitive salary and benefits.
The Sales & Affordability team is a new department within Clinical Programs and Evaluation that will support the company in delivering high value products and programs to our employer groups and members. The Affordability team will be focused on analyzing cost trends and implementing savings strategies.
ROLE OF AFFORDABILITY CONSULTANT:
The primary role of the Affordability Strategy Consultant is to partner with Actuary to evaluate and monitor the cost of care trends, translate evaluation findings into actionable improvements, and develop solutions that will have a positive impact on the global cost of care for our members and employer groups. The Affordability Strategy Consultant collaborates cross functionally across the enterprise to provide consulting services and project management and will act as the overall business owner to implement identified cost saving strategies that may span product development, provider payment policies, clinical programs, care management or other operational units.
Under the general supervision of the Medical Director, Sales & Affordability, the incumbent’s accountabilities may include, but are not limited to, the following:
1. Trend Analysis
• Represents Medical Affairs in trend analysis work group that is charged with evaluating and monitoring utilization and cost trends.
• Analyze factors that are driving trend, including cost and utilization.
• Develop actionable insights and recommendations based on trend evaluations.
• Develop deep understanding of health plan products, provider payment policies and clinical programs and how various factors may impact trend.
• Partner with Actuary team to determine what business questions should be evaluated and how they should be measured.
• Partner with Actuary team to evaluate changes that have been implemented and whether those changes have demonstrated success in modifying trend in a positive direction.
2. Panel Translate Evaluation Findings into Actionable Improvements
• Present and communicate insights and recommendations from trend analysis work group to leadership within Medical Affairs and Marketing, among others.
• Collaborate with these internal stakeholders to identify and prioritize high impact opportunities for savings that may span product development, provider payment policies, clinical programs, care management or other operational units.
3. Develop and Lead Cross-Functional Work Teams to Implement Cost Savings Strategies
• Develops relationships across the enterprise and collaborates with internal stakeholders to formulate work teams for each identified cost savings strategy.
• Manages the full project management life cycle for the implementation of each strategy.
• Develop and execute work plans, including project goals and objectives, timelines, resources, and measures of success.
• Provide verbal and written communications on project status to leadership; make recommendations on project decisions.
• Coordinate the resolution of resource, budgeting, change, and legal issues.
• Proactively identify risks and opportunities associated with implementation and develops a mitigation plan.
• Bachelor’s Degree in Public Health, Health Administration, Business Administration, or related field. In lieu of Bachelor’s Degree must have 4 years of related experience
• At least five years of experience with progressively increasing responsibility in the healthcare environment, health insurance payer environment, or related industry.
• General understanding of health care claims data, trend analysis, and insurance operations and products.
• Proven track record of collaborative, analytic problem solving. An ability to present and discuss analytical information in a way that is persuasive and advances understanding.
• An ability to provide insights and actionable improvements for product and program design, based on analytic findings.
• Ability to lead cross-functional work teams with a multidisciplinary approach.
• Solution oriented with a proven ability to execute on work plans.
• Thrives in a highly matrixed, cross-functional environment. Strong interpersonal skills, with the ability to effectively influence and collaborate with employees and management at all levels.
• Ability to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality.
• Well organized, able to multi-task and exhibit flexibility.
• Effective written and interpersonal communication skills, including executive level presentation skills.
• Strong computer skills including Microsoft Excel, PowerPoint, Word, and Outlook.
• 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.
• Master’s Degree in Public Health, Health Administration, Business Administration, or related field.
• Experience in one or more of the following areas:
o Consulting skills and/or direct experience in a consulting role
o Experience in a clinical or insurance setting or knowledge in a clinically related field
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.
Please apply before: 6/14/2020
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