CareFirst Careers

Clinical Advisor

Resp & Qualifications

PURPOSE:

The Sales & Affordability Strategy team, serves as a consultative support team within Health Services dedicated to Commercial accounts, account executives and the account management team. The team is comprised of clinical professionals and healthcare strategists who specialize in data analysis, healthcare analytics and population health management. This team along with account executives, proactively reviews all aspects of the account data to provide strategic subject matter expertise, analysis and recommendations on benefit 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 proprietary data 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 along with wellness consultants, 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’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 Account Executives and Wellness Consultants, make recommendations to help clients (employer groups) meet their corporate goals and key initiatives relating to the health and welfare of their employee population. The Clinical Advisor serves as a key subject matter expert and strategic partner for the Commercial 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 VP of Clinical Programs & Affordability Strategy and will be responsible for advancing and growing our Commercial Sales 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 VP of Clinical Programs & Affordability Strategy, the incumbent’s responsibilities include, but are not limited to, providing clinical analysis and subject matter expertise as follows:

Expert at reviewing and presenting population health information, ability to investigate large employers’ high cost utilizers as well as key cost drivers from a clinical perspective; Ability to communicate the value CareFirst offers, ability to communicate CareFirst’s population 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 care support programs. The incumbent will make strategic recommendations to large employer accounts with the goal of improving health quality outcomes and controlling costs for their employee populations. Coordination with Commercial Sales account management teams, Health Services team, Client Advisors, CareFirst Wellness consultants, Marketing & Government Affairs, will be required to ensure productive and impactful employer, consultant and broker meetings are conducted.

Monitors the status of high cost claimants through the member information. Reports this data to the Sales Account Executive and/or Manager, underwriting and preferred StopLoss vendors as requested.

Maintains strict HIPAA guidelines to ensure that members’ PHI is kept confidential and protected.

Subject Matter Expertise: 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., Care Management, Clinical Programs, Patient Centered Medical Home (PCMH) and other Value Based Payment Models, 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. Brings client and consultant feedback internally for further program refinement and enhancements.

Project Management: Works in collaboration with the account executive team to identify client specific initiatives and tailored solutions and will include project management and oversight of the identified custom build. The purpose will be to identify strategic needs for key accounts and their consultants/brokers and manage the build of these custom solutions. In addition to client facing projects, the incumbent will need to lead internal projects to support Health Services goals and initiatives.

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 population health data and trends to our clients in order to appropriately support our clients and strengthen CareFirst's relationship. Key measures of success will include the retention and expansion of CareFirst’s existing employer group accounts, awareness, understanding and appreciation of both the value CareFirst offers, and improved client satisfaction as evidenced by client surveys. This incumbent must be able to work in a matrix management environment with functional areas of the organization (Sales, Health Economics and Health Services).

QUALIFICATION REQUIREMENTS:

Certification/Licensure:
• Must be currently licensed as a registered nurse (RN)

Experience:
• Minimum of 4+ years’ experience working as an RN
• Demonstrated experience with healthcare data analysis
• Ability to present in front of both small and large audiences

Abilities/Skills/Knowledge:
• 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.

Preferred:
• Related undergraduate (BA/BS) or graduate degree such as MSN, MBA, MPH

• Experience in the Behavioral Health field strongly preferred
• Knowledge of health plan sales or account management
• Experience working in a health plan environment in a business role

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 physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position, successfully. Requirements may be modified to accommodate individuals with disabilities.

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 employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted. Frequent driving is required.

Department

Department: Clinical Advisors MD

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: 4/14/21

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

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