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Clinical Appeals Manager (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: This role manages the appeal process for members and providers who appeal on behalf of members for all lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and ...1 week ago on Professional Diversity NetworkTools -
Care Manager (Remote)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member's medical andbehavioralhealth needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary ...1 week ago on Professional Diversity NetworkTools -
Obstetric Care Manager (Remote)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: Under minimal supervision, the Obstetric Nurse Care Manager researches and analyzes an Obstetric member's medical and behavioral health needs and healthcare cost drivers. The Obstetric Nurse Care Manager works c...1 week ago on Professional Diversity NetworkTools -
Vice President & Deputy General Counsel (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: The Deputy General Counsel leads CareFirsts Office of Corporate Counsel (OCC), with approximately 70 indirect reports, and is responsible for providing excellent, consistent, and comprehensive legal services to ...3 weeks ago on Professional Diversity NetworkTools -
Vice President, Quality, STARS & Risk Adj (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: We are looking for an experienced leader 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 ...Over 4 weeks ago on Professional Diversity NetworkTools -
Utilization Management Supervisor (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health care services and compliance with UR policies/procedures, as well as, regulatory...Over 4 weeks ago on Professional Diversity NetworkTools -
Oncology Care Manager (Remote)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: Under minimal supervision, the Oncology Care Manager researches and analyzes a member's medical andbehavioralhealth needs and healthcare cost drivers. The Oncology Care Manager works closely with members and the ...Over 4 weeks ago on Professional Diversity NetworkTools -
Senior Risk Management Analyst (Hybrid) - Third Party Risk Management
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: The Senior Risk Management Analyst is responsible for supporting, facilitating, and training associates on operational risk programs designed to ensure the identification and mitigation of risks; management of co...Over 4 weeks ago on Professional Diversity NetworkTools -
Care Manager (MD-DC-Northern VA) (Remote)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE : Under minimal supervision, the Care Manager researches and analyzes a member's medical andbehavioralhealth needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary ...Over 4 weeks ago on Professional Diversity NetworkTools -
Sales Enablement Data Analytics Manager (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: The purpose of the Sales Enablement Manager and Network Data Analytics is to execute on business objectives with data and to ensure alignment with the vision of the Network Innovation and Strategy team (the busin...Over 4 weeks ago on Professional Diversity NetworkTools -
Venture Capital Manager (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Washington, DCResp & Qualifications PURPOSE: The Venture Capital Manager will play a key role in sourcing and evaluating new investment opportunities, executing on investment theses, and supporting our portfolio companies. ESSENTIAL FUNCTIONS: Seek out...Over 4 weeks ago on Professional Diversity NetworkTools -
Commercial Accounts Director (Mid-Market) Remote
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications Candidates must live in the MD/DC/VA surrounding areas in order to travel frequently into the offices and client meetings. PURPOSE: The Director, Commercial Accounts (middle-markets) provides strategic direction to the ...Over 4 weeks ago on Professional Diversity NetworkTools -
VP, Chief Ethics & Compliance Officer (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: The VP, Ethics & Compliance oversees and manages the Company's Corporate Ethics & Compliance Program, serving as an independent and objective individual that reviews and evaluates compliance issues and concerns w...Over 4 weeks ago on Professional Diversity NetworkTools -
Pediatric Medical Director (Hybrid)
Management & Exec · Carefirst Bluecross Blueshield · Baltimore, MDResp & Qualifications PURPOSE: The Medical Director oversees all activities of utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans - specifically with ...Over 4 weeks ago on Professional Diversity NetworkTools -
Manager, Specialty Pharmacy Business - Financial Value & Solutions (Remote)
Management & Exec · Carefirst Bluecross Blueshield · Owings Mills, MDResp & Qualifications PURPOSE: The Manager, Specialty Pharmacy Business Financial Value & Solutions is responsible for the oversight and execution of strategic plans and financial operations for the Pharmacy business. This strong leader will ...Over 4 weeks ago on Professional Diversity NetworkTools
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