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Resp & Qualifications
Clinical programs are CareFirst’s primary vehicle for promoting and achieving the best possible population health and financial outcomes for its members. A Program Evaluation Specialist is responsible for measuring and evaluating the performance of a portfolio of clinical programs, collaborating with Clinical Leadership, Program Managers, care coordination teams, and data analysts to:
1) Establish consistent programmatic and outcomes-based evaluation criteria for each program in their portfolio;
2) Design relevant analyses to assess program impact and identify areas for improvement and refine analytic requirements;
3) Work with various data sets, extracting and manipulating the data to produce insights and actionable improvements;
4) Work with program managers to translate evaluation findings into actionable improvements in their programs;
5) Assist in the roll-out of new programs in order to incorporate rapid-cycle feedback and learning from day one.
Program Evaluation Specialists will work with a small, intellectually diverse and multidisciplinary team, documenting quantitative and qualitative progress toward the triple aim of improving health outcomes, reducing cost of care, and improving the overall care experience for all CareFirst members and accounts.
The objective of the clinical program evaluation group is to help establish the Company’s reputation as a national leader in performance measurement and delivery system transformation by shaping the presentation of programmatic results.
PRINCIPAL ACCOUNTABILITIES: A Program Evaluation Specialist’s responsibilities include, but are not limited to, the following:
1. Establish evaluation criteria and reporting for each clinical program in their portfolio
Work with the relevant Clinical Leadership, Program Managers, and Program Directors to ensure Clinical Programs are meeting their objectives. This includes an assessment of the quantitative and qualitative metrics of the guidelines to ultimately assess whether and how the programs derive value. In addition, identify the appropriate approach to generate measurable metrics for: 1) improvement in health outcomes for members; 2) returns on investment, including reductions in medical cost and healthcare utilization; and 3) operational/process efficiency.
• Build strong relationships with relevant clinical leaders and program managers and a deep understanding of their programs;
• Collaboratively develop an analytic framework and criteria for measuring and tracking outcomes for each program in their portfolio;
• Define process and outcome measures for each program, including clinical and financial indicators of success and operational indicators for each program component;
• Deploy a variety of quantitative and qualitative methods to conduct program evaluation – analysis of clinical/financial outcomes; comparison group construction, trend analysis, financial modeling; and, as necessary, more advanced statistical methods.
• Choose methods based on: 1) the question being asked; 2) the timeframe for delivering and answer; 3) the degree of confidence required in the answer; and 4) the availability of the data.
• Collaborate with the data analytics and management teams to understand the nuances and limits of the data and the production of timely reporting
• Collaborate with the program management teams to assess relevant qualitative metrics and document insights from patient-facing staff
2. Design relevant analyses to assess program impact and identify areas for improvement and refine analytic requirements
Align with healthcare analysts to translate evaluation metrics, as well as analytics, into actionable insight.
• Collaboratively problem-solve analytic approaches with the full Program Evaluation team;
• Craft the technical documentation for each data request, including researching any necessary clinical definitions, quality metrics, or relevant code-lists;
• Adapting methodology based on industry standards that constructively navigates the trade-off between whether a given analysis should be one-off or standardized;
• Perform modeling and analytics based off data availability and significance of the project, including exploratory analyses and identifying new data sources
• Creating and communicating polished presentations for relevant stakeholders, including clinical leads, program consultants, care coordination teams, and senior Company leadership.
3. Collaborate with clinical leaders and relevant stakeholders to translate evaluation findings into actionable improvements in their programs
Assist Clinical Leaders and stake holders in deriving actionable insight from evaluations and analyses.
• Support data reporting and shaping its interpretation with the data and technical teams at CareFirst as well as with the vendors;
• Engage in design of supported improvements and initiating problem-solving meetings with relevant clinical and program stakeholders;
• Provide analytical insights by creating and delivering presentations on relevant findings;
• Creatively brainstorm solutions to identified issues and challenges.
4. Assist in the roll-out of new programs in order to incorporate rapid-cycle feedback and learning from day one.
Help to ensure that new programs are built with evaluation principles in mind from day-one.
• Participate in the design discussions and problem solving for new programs in their portfolio;
• Creatively identify opportunities to improve the ability to assess program performance through design choices;
• Effectively communicate the value and potential impact of an evaluation-centric design approach to relevant stakeholders.
• A master’s degree in economics, health policy, health services research, health informatics or related field.
• 2-4 years of healthcare analytic, consulting, or program evaluation;
• Demonstrated proficiency with quantitative modeling and the creation of analytic presentations;
• Skilled in working with large data sets, analyzing data and using results to provide insights and actionable improvements in program design and implementation;
• Must be able to not only extract and manipulate data but understand what the data represents and review critically to ensure that it is accurate and reasonable within the context that it is presented;
• Coding and/or advanced quantitative modeling experience, and willingness/confidence to learn new tools;
• Exposure to quantitative methods, ideally in finance, economics, or health services research;
• Applied advanced knowledge of statistical methodologies, as well as experience working with claims and/or other clinical data is advantageous, but not required;
Skills & Abilities:
• Strong project management and organizational skills;
• Strong teamwork and interpersonal skills, an ability to present and discuss technical information in a way that establishes rapport, persuades others, and gains understanding.
• 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;
• High level understanding of delivery system and policy and business environment to improve quality of care and reduce costs.
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
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