Program Manager - Payment Policy (Hybrid)

Resp & Qualifications

PURPOSE:

Manages end-to-end oversight of payment policy initiatives in conjunction with Medical Policy, Utilization Management and Configuration teams. Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive strategies and maximize outcomes related to ROI, provider satisfaction, and organizational metrics and performance. The ideal candidate will have experience in payment policy, utilization management, medical coding and knowledge of Facets. We are looking for an experienced professional in the greater Baltimore/Washington 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. 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). 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.
• Measures, evaluates and reports on program(s) performance related to ROI, customer satisfaction, and other organizational metrics. Effectively forecasts and manages people, process and technology related resources to ensure successful achievement of corporate goals.
• Guides stakeholders and leadership through key decisions and communicates and coordinates activities internally and across network of partners.
  
  

Supervisory Responsibility

Leads a team utilizing a matrix management system.

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

• The ideal candidate will have experience in payment policy, utilization management, medical coding and knowledge of Facets.
• Project Management Professional Certification (PMP) a plus.
  
  

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: $106,632 - $211,783

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).

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.

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