CareFirst Careers

Regulatory Policy Consultant

Resp & Qualifications

The Consumer Direct SBU (Strategic Business Unit) Operations Mandates Program Director provides strategic direction and oversight for SBU activities related to all Mandates implementations, including the Affordable Care Act (ACA).  This role is directly accountable for the quality and cost-effective development and maintenance of various mission-critical projects supporting operational effectiveness of the ACA and all associated Consumer Direct Strategic Business Unit (CD SBU) initiatives linked to the program or any other mandates (BCBSA, state, federal) that have impacts on CD SBU operations and business functions.  Additionally, the incumbent will analyze and assess current state business processes, identify and propose improvements, diagnose more complex operating systems gaps and issues, and lead the implementation of new business operating processes.

The incumbent will represent the needs of the CD SBU in the development of projects and programs, conduct analysis of program inputs and outcomes and create executive level materials.

This position acts as program director for a complex program of strategic/regulatory ACA and Mandates  projects that that have a significant regulatory compliance, legal and/or financial impact to CareFirst Business.  The incumbent will manage and be responsible for all aspects of the program including risk management, business process improvement, organizational change readiness and technology applications/development, enabling the business to meet the regulatory requirements, future goals and objectives prioritized by Senior Management.

The individual serves as subject matter expert for CD mandates operations, providing guidance to both intra-departmental colleagues and inter-department project teams.  The position interacts very closely with Mandates and TOS counterparts, Compliance and all functional areas within the SBU as well as with teams at all three Exchanges (MHBE, DCHL and FFM).  This role requires an understanding of ACA business and program requirements, SBU and regulatory strategic imperatives, industry mandates and process improvement.

Under the general supervision of the Sr. Director OTS and Projects, the incumbent’s accountabilities may include, but are not limited to, the following:


• Transitions initiative from idea and business need and requirements to solution through the SDLC process and deliver significant operational improvement, acting as change agent to the organization.
• Manages the full project management life cycle and software development life cycle for the implementation of highly complex, large scale, strategic/regulatory corporate initiatives within the SBU.
• Manages and directs the program and project staff to oversee the impacts and interdependencies between programs and works to ensure initiatives meet the CareFirst goals and objectives of the Executive leadership team.  Perceived by peers and staff as a leader.
• Works closely with counterparts in Mandates and TOS and Exchange personnel to ensure alignment between organizations on goals and timing of activities.
• Provides both verbal and written communications regarding project status, risks, issues, and makes recommendations on project/program decisions to Executive Management.
• Manages allocation of resources within the program(s) to meet work fluctuations and budget and time constraints in the delivery process.  Creates a high performing team.
• Serves as subject matter expert, providing technical and analytical guidance to the program and project teams.
• Works with the Business areas within the SBU on the necessary Operational Readiness activities providing support and coordination to ensure adoption of new systems and business processes in the CareFirst environment. 
• Manages contracts and vendors assigned to corporate initiatives included in the assigned program(s).
• Identifies, categorizes and proactively manages program risks using a structured approach.

• Analyzes, defines and interprets business needs and issues across the entire SBU, affecting multiple systems and departments, by gathering, analyzing, documenting and validating current-state operating processes and determining required changes.  Responsible for coordinating with Business Process team to implement changes in necessary timeframe.
• Investigates process issues, identifies causes of problems, and assists appropriate teams to solve and correct problems. Tracks corrections to conclusion.
• Maintains communications with TOS, Mandates and other business counterparts to share cross-functional issues and to support issue identification and resolution.

• Defines and establishes technology-based Consumer Direct mandates strategies to ensure consistency and alignment with Corporate and Divisional segment goals. 
• Provides support in identifying the appropriate solutions required by the user areas within the SBU
• Provides insight, functional expertise, technical expertise, and knowledge of the business operations, strategies, priorities and business requirements to support the technical direction of the SBU. 
• Forges relationships with both TOS and the SBU to understand issues and concerns, provides the correct level of support, and proactively identify business opportunities.

• Directly responsible for management of activities to create, validate and deliver Summary of Benefits and Coverage annually for all lines of CD Business.
• Oversee SBU team responsible for validation and execution of SBCs under federal regulatory timelines
• Act as the primary point of contact with TOS project team responsible for the technical execution of SBCs and work collaboratively with them to resolve issues and risks

• Responsible for managing day to day as well as  Program Budget across all projects included in the program, with overall budget accountability.  . 
• Maintains current statements of work for all contractors; tracks and approves contractor invoices for projects under their program(s) in a timely manner.
• Provides regular updates to management, project sponsor and stakeholders on the status of the budget. Documents reasons for budget excess or shortfall.

• Provide direction, prioritization and motivation to team, in order to manage allocation of resources to meet work fluctuations and budget and time constraints across multiple program and governmental mandates.
• Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. 
• Delegate responsibility and authority to appropriate staff within the team. 
• Accountable to drive the performance assessment of all direct and indirect reports, generates development plans and sets goals within the context of the corporate policy.  Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and training. 


Required Knowledge and Experience:

• BA/BS degree in Computer Science, Business or related field or equivalent experience
• 8+ years of related program/project management experience in a large scale, cross functional, multi-system environment.
• 10+ years related healthcare experience
• Project Management Professional (PMP) certification
• Progressive broad-based information systems experience (which could include consulting) with state-of-the-art hardware and software systems; knowledge and implementation experience in new computing architectures and networked computing structures. 
• Ability to grasp technological opportunities and apply them to business opportunities and requirements.
• Experience in execution of multiple related development projects simultaneously, particularly as Project Manager on systems development, with working knowledge of  Systems Development Lifecycle and the Project Management LifecycleMust have subject matter expert level knowledge of the Affordable Care Act and impacts within the Individual/Consumer Direct segment of the insurance industry.  

Required Skills and Abilities
• Thorough knowledge and understanding of the company’s business practices and direction, busi¬ness principles, and business processes, plus familiarity with the company’s products and resources.
• Ability to motivate and lead dynamic, energized, and highly creative multidiscipline high-performance work teams in learning and applying new skills/techniques to respond to business needs.
• Demonstrated leadership skills.  Experience with coaching, mentoring and providing feedback to associates/team members.
• Ability to influence decision makers and lead discussions with groups that may have diverse and conflicting perspectives on business needs and solutions
• Excellent interpersonal skills including the ability to build consensus and agreement
• Advanced written and verbal communication skills; an ability to present and discuss technical and business solutions in a way that establishes rapport, persuades others, and gains understanding.
• Proven ability to work well as part of a team and as an individual contributor and thrive in a cross functional environment
• Strong management, business planning, and development skills.
• Ability to effectively adapt to rapidly changing technology and apply it to business needs
• Exceptional program and project management skills, effectively arranging resources and managing multiple large and complex ongoing projects in a cross-functional environment, work flow balancing, activity scheduling, problem resolution and flexibility.
• High level of analytical, problem solving and conceptual skills
• Extensive PC skills including Microsoft office software such as Word, Excel, Visio and Power Point.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.Ability to work some evenings and weekends is required.

• Five or more years of CareFirst experience preferred
• Master’s degree in Computer Science, Business or related field or equivalent experience
• Prior health insurance industry exposure, specific experience with successful project implementations and /or previous healthcare consulting experience
• Working knowledge of Lean Six Sigma

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:

Closing Date

Please apply before: 4.30.21

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.


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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