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
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… 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 Digital Product Management team is leading this charge by advancing our Value Stream ways of working within Digital Factory and Strategy. To drive this transformation, … Read more
Resp & Qualifications Purpose… Under general direction of senior-level accounting personnel, perform intermediate-level professional accounting responsibilities, including, but not limited to, preparing basic financial statements, journal entries, reconciliation of financial data, and preparation of financial reports from the General Ledger. Essential Functions: • Verification of general ledger data through development and maintenance of monthly reconciliations/analyses … Read more
Resp & Qualifications Although this position is REMOTE, candidates MUST live in the MD, DC, VA , PA, DE and surrounding areas in order to travel to offices and client meetings. PURPOSE: The Manager, Specialty Pharmacy Financial Value & Solutions is responsible for the oversight and execution of strategic plans and financial operations for the … Read more
Resp & Qualifications PURPOSE: We are looking for a Software Engineer in our Card to Care Value Stream. This role operates in a pod focused on our Pharmacy Benefit Management IT solution. As a Software Engineer, you would design, develop/code, test, and document application programs for computer systems. This role works with appropriate stakeholders to … Read more
Resp & Qualifications PURPOSE… Provides leadership to CareFirst’s third-party vendor management strategy and execution. The Director helps to build the vendor management office at CareFirst and will collaborate with leaders and internal stakeholders across all Business Units to ensure that the management of vendors is executed consistently and efficiently across all levels. Such strategies will … Read more
PURPOSE : Assists with the design, developing / coding, testing, and documentation of application programs for computer systems. Works with appropriate stakeholders to define system scope and objectives… Performs analysis and debugging of computer software and / or equipment. Performs in accordance with established project standards and processes. Breaks down software requirements and assists with … Read more
Resp & Qualifications PURPOSE… Performs the day-to-day administration of the ServiceNow platform across various environments. Maintains the stability and usability of the platform, manages support for incidents, and manages upgrade planning and execution. Oversees the security of the ServiceNow platform, creating and enforcing security standards throughout the platform. Supports application delivery through managing ServiceNow application … Read more
PURPOSE : This role is responsible for developing complex new business opportunities within the Commercial Markets Division. This position represents the organization in acquisition strategy development, prospecting, network analytics, financial evaluation and negotiating with clients and brokers using consultative selling skills in order to grow new business and enhance… profitability. ESSENTIAL FUNCTIONS : Aggressively grow … Read more