Apply on Employer Site

CareFirst BlueCross BlueShield · 23 hours ago

Senior Business Consultant (Remote)

United States

Full-time

Remote

Senior Level, Lead/Staff

$120K/yr - $214K/yr

10+ years exp

CareFirst BlueCross BlueShield is seeking a Senior Business Consultant to modernize and redesign the utilization management department within the Health Services division. This role involves providing expertise in utilization management workflows, collaborating on business strategy, and leading cross-functional teams to improve operational efficiencies.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Provide subject matter expertise in utilization management workflows and technology platforms as well as project management, finance and budget, data and metrics, information technology, etc., that contributes to the effective accomplishment of initiatives, tasks and goals

Collaborate on the business strategy, thesis, programs and the identification of strategic opportunities. Drive the exploration of opportunities for automation and driving efficiencies for the UM teams

Proactively leads cross-functional teams and projects between divisions, and internal and/or external stakeholders to deliver value to the utilization department and Health Services division

Proactively identify ways, means, and platforms to build synergy and mutually reinforcing workstreams to accomplish tasks more effectively across different business functions of initiatives

Assist in developing, standing up and operationalizing technology platform optimization to track progress, programs, and impact for supported service area

Design and run dashboards to support clear communication across vertical components of business

Review and support task coordination while identifying potential process improvements

Develop and finalize budgets, policies, and other documentation for programs

Build trusted relationships within and across CareFirst to deepen subject-matter expertise, find opportunities to synchronize, and ensure close coordination with teams in their areas of responsibility

Identify opportunities for synergies to improve task execution across the organization

Work collaboratively with other support partners within current and upcoming programs

Communicate strategy, programs, and next steps to leadership and key stakeholders

Qualification

Utilization ManagementClaims System ConfigurationProject ManagementGuiding CareFacetsData AnalysisRelationship ManagementMS OfficeCustomer ServiceCommunication SkillsStrategic ThinkingProblem Solving

Required

Bachelor's Degree 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

10 years experience in business development, operational technology support, general business operations and/or consulting experience

Understands business goals and priorities

Follows evolving market, industry and consumer trends

Effective communication of complex ideas both verbal and written

Exceptional project management, facilitation and organizational skills

Excellent relationship management skills

Strategic thinker, problem solver, and a collaborator who can drive engagement and discussions

Significant experience with MS Office (Excel, PowerPoint, Word)

Strong analytic skills utilizing tools such as Power BI, Excel, etc

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

Must be eligible to work in the U.S. without Sponsorship

Preferred

Deep understanding of utilization management in order to act as a liaison between the UM clinical teams, the technical support teams, and the claims operations teams

Working knowledge of claims system configuration, including claims edits, is needed to ensure alignment of authorization to claims processing

Deep understanding of proper plan design across all commercial and government programs plans and experience administering plans in a large payer organization is helpful

Overall technical knowledge and understanding of Guiding Care, Facets, and other key systems is helpful when exploring opportunities for automation and driving efficiencies for the UM teams

Ability to work across multiple business areas, collaborate with peers, clinical, clinical support, medical director, and other levels while ensuring alignment with department and organizational goals is crucial to be successful

This position must be able to work efficiently and independently to move critical initiatives forward in alignment with direction established through thought partnership with the Director of UM and the VP/CMO of Medical Management

Ability to use proper change management principles is important as this role will be involved in changes made to the clinical and clinical support operations and processes

Professional level communication skills and the ability to participate in and lead conversations and meetings will aid the overall success of the department