Resp & Qualifications PURPOSE… Provide a range of communications support from strategic communications planning to execution, including planning events, developing marketing campaigns for those events, and leading other client communications initiatives, including outreach campaigns to drive acceptance of policies and . Draft and edit a variety of communications materials and products, including talking points, leadership … Read more
Resp & Qualifications PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member’s medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and … Read more
Resp & Qualifications PURPOSE: The Inpatient Management Clinical Navigator (RN) manages the timely and smooth transition from inpatient care to home or other levels of care utilizing experience and skills in both care management and utilization management including proficiency in established guidelines to determine medical necessity, appropriate level of care, and case management to engage … Read more
Resp & Qualifications PURPOSE: Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic… technical assistance and troubleshooting … Read more
Resp & Qualifications PURPOSE… The Technician, Enrollment I is responsible for ensuring that members are accurately enrolled into CareFirst member enrollment systems in a timely manner, and according to the account contract or service agreement. To accomplish this, the associate in this role may interact and coordinate activity with key client account contacts, subscribers, CareFirst … Read more
Resp & Qualifications PURPOSE: The Sr. Business Consultant provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support initiatives in the changing healthcare industry. This position will lead efforts for the implementation and maintenance of a Contract Responsibility Matrix to manage business risks relating to its operations under … Read more
Resp & Qualifications PURPOSE… Investigate and perform adjustment of complex claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit … Read more
Resp & Qualifications PURPOSE: On behalf of Executive Leadership, coordinates all division-wide activities related to strategic planning, budget, corporate reporting and compliance. Assists senior management in the development of divisional goals and monitors progress toward goals across the division coordinating with all functional areas, creating detailed work plans and timelines, implementation and post implementation follow-up … Read more
Resp & Qualifications PURPOSE… CareFirst is undertaking a digital transformation which requires enterprise agility paired with the retooling of our technology stack to speed delivery and expand our reach. The IT Core Technology Services organization is leading this charge by advancing our operating model across the organization. To drive this transformation, the Project Coordinator supports … Read more
Resp & Qualifications PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre and post claim medical review for Commercial and … Read more