Job Details

RESP & QUALIFICATIONS

This position will support the modernization and redesign of the utilization management department. Utilizes data analytics and supports a set of business initiatives designed to help extract value from information. Develops data visualizations for analysis, problemsolving, and business solutions for the utilization management team and related clinical partners. This role will lead the creation of operational dashboards in PowerBI to support data driven decision making for the business leadership team. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Provides healthcare analytics support to generate insights in the form of dashboards, metrics, or reports for UM related solutions.
• Operates as a thought partner with business leads to perform both proactive and reactive analysis for key stakeholders and derives insights between key metrics and their drivers.
• Develops meaningful reports and analysis for the UM leadership team, team members and related stakeholders and presents on findings.
• Monitors key performance indicators and balanced scorecards to aid in improved decision-making.
• Supports infrastructure that fosters analytical rigor and develops models and tools that drive healthcare strategy.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Statistics, Mathematics, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Upon Hire Preferred:

• Certified Business Intelligence Professionalor
• Certified Business Analysis Professional (CBAP)

Experience: 3 years experience with business intelligence tools, data analytics and/or database management systems.

Preferred Qualifications:

• Experience creating dashboards to support internal productivity reporting and external KPI reporting.
• Knowledge of utilization management from a payer perspective is preferred.
• Understanding of utilization management processes and industry standards is helpful as this role will lead the creation of operational dashboards in PowerBI to support data driven decision making for the business leadership team.Experience in creating dashboards and ensuring accurate reliable data in to be used daily for operations and for reporting out important measures to show the value of our UM product for both internal and external stakeholders.
• Overall technical knowledge and understanding of Guiding Care, Facets, and other key systems is helpful.Ability to collaborate with peers, clinical, clinical support, medical director, and other levels while ensuring alignment with department and organizational goals is crucial to be successful.

Knowledge, Skills and Abilities (KSAs)

• Ability to translate technical complexities to key business stakeholders.
• Ability to learn and understand all areas of operations within the organization.
• Ability to think creatively and critically and thrive in a fast-paced environment.
• Proficient in business intelligence software, such as PowerBI, Qlik, or Tableau.
• 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.

Salary Range:

$69,048 - $137,137

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Clinical Utilization Management

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

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.

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