Resp & Qualifications

PURPOSE:

Manages end-to-end oversight of custom (ie.Domestic) network development in support of national account sales. The Program Manager will work across two high profile divisions driving membership growth through network implementation with a focus on client satisfaction. The Program Manager will be on the Value and Sales Enablement team in Health Services Division and work directly with the Account Executives and Consultants in the Sales Division and may be account-facing when needed to address all domestic network set up, maintenance, and enhancement requests. The Program Manager will work with the new business team at the initiation of the proposal through account implementation to ensure successful network set up and customization per account request. This Manager will lead interdisciplinary teams and internal projects to maintain and enhance program performance over time. The Program Manager will also work directly with a dedicated Functional Analyst to maintain accuracy network data and build and improve processes to ensure all custom network requests are implemented in the provider data system and data flows downstream to necessary platforms (ie. Provider directory and claims system). Strong communication skills will be needed to guide stakeholders through key decisions, communicate and coordinate activities internally and across departments. Facilitation of process improvement and identification and articulation of stakeholder needs will be essential to drive strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance.

Note: We are looking for an experienced professional in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

• Manages complex program(s) or strategic initiatives that span organizational boundaries and have a significant legal and/or financial impact to CareFirst Business. Write and maintain all domestic network SOPs with details of custom set-up unique to each account. Understand the network set-up and service model based on platform (CareFirst, CFA, National Alliance). Identifies process improvement opportunities and takes action to implement enhancements to maximize outcomes and growth.

• Coordinates with internal and external stakeholders to launch, maintain, and enhance complex program(s). Deliver regular reports to account team on network status, adequacy, and utilization. Provides direction and motivation to project teams in a matrixed environment. Drives outcomes by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors. Liaise with Sapphire Digital team to ensure custom account directory is established and accessible to members based on client requirements. Work with provider contracting and other provider-facing teams as needed to ensure successful domestic network performance.

• Measures, evaluates and reports on program(s) performance related to ROI, customer satisfaction, and other organizational metrics. Develop domestic network strategy during RFP process, participate in finalist meetings if necessary. Serve as the subject matter expert on network design and support account team with network enhancement suggestions. Effectively forecasts and manages people, process and technology related resources to ensure successful achievement of corporate goals. Assist account team on crafting value language for member materials around the domestic network product.

• Guides stakeholders and leadership through key decisions and communicates and coordinates activities internally and across network of partners. Work directly with Functional Analyst to ensure all domestic network data is kept up-to-date and accurate based on account requests. Help to troubleshoot claims processing issues with domestic network providers. Connect any customized clinical programs managed by Health Services to domestic network product and support operations of these programs.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Management 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 Preferred:

Certified Project Management Professional (PMP)-PMI

Experience: 8 years project management or program management experience.

Preferred Qualifications:

• Master's Degree.

• Project Management Professional Certification (PMP).

• Experience in account management and/or network development, provider contracting, and provider relations.

• Knowledge and/or experience with provider data, provider credentialing requirements, and common data elements (ie. NPI, TIN, etc.).

Knowledge, Skills and Abilities (KSAs)

• Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.

• Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.

• Ability to translate business needs as it relates to technology, systems, and vendor platforms.

• Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.

• Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.

• Knowledge and discipline of Process Improvement.

• Use of Microsoft Applications.

• 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: $100,800 - $200,200

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 responsibilites 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

Market Value and Sales

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.

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

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REQNUMBER: 19674