32 program coordinator jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing 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, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team including case managers, social workers and discharge planners...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Pharmacist will perform comprehensive clinical services with a focus on utilization management for specialty drugs covered under the pharmacy and medical benefit. Responsibilities will include but not are limited to utilization management program development and monitoring, coverage criteria development, clinical drug evaluations, development of drug management tools, and vendor oversight for delegated programs. This position will work in a matrixed environment across the organization. ESSENTIAL FUNCTIONS: Develops and executes on strategies to manage pharmacy and medical benefit drug spend with a focus on specialty drugs. Tracks productivity, quality, impact, and overall performance of utilization management strategies. Identifies areas where program modifications could result in improvements to patient outcomes and reduce costs. Works collaboratively with vendors, PBMs, and internal...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing 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, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may also be required to come to the CareFirst office...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing 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, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may be required to come to the CareFirst office location...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Vendor Management Manager is responsible for driving key business relationships with critical business partners, managing global partner issues, and working with internal teams such as Information Technology to ensure understanding of customer and business needs. This position will contribute to enhancing and optimizing the processes and workflows established between CareFirst and contracted vendors. In addition, the Vendor Management Manager will hold vendors accountable for contracted performance guarantees to ensure members receive the highest quality of service and ensure financial compliance to contracts. This role will manage a stable of vendors in the Information Technology space. ESSENTIAL FUNCTIONS: Responsible for overseeing the vendor management process including supervision and monitoring of Division vendor performance. Responsible for ensuring processes are in place to monitor vendor...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are seeking a Lead Site Reliability Engineer who will ensure the reliability, availability, and operational integrity of the enterprise Data & Analytics ecosystem, including data platforms, interoperability services, streaming infrastructure, APIs, and analytics environments. This role serves as the primary incident commander, problem manager, and reliability leader , coordinating technical teams and business stakeholders during service disruptions while driving root cause remediation and systemic reliability improvements. This individual operates as a cross-functional reliability authority , bridging engineering, platform, interoperability, governance, and business teams to ensure critical data services meet defined service level objectives and operational expectations. ESSENTIAL FUNCTIONS: Incident Management and Command : Serve as the primary Incident Commander for Severity 1 and...

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CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying and verifying the needs of business or user. The incumbent assists in the gathering and synthesizing of business requirements for low complexity software, systems, processes and/or services and translates them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as the conduit between the business area and the technical or software development team through which requirements flow. ESSENTIAL FUNCTIONS: Interpret business needs and issues by gathering, eliciting, analyzing, documenting and validating the Business area?s user and technical (functional/non-functional) requirements....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Regulatory Compliance Analyst will conduct independent analysis for complicated, high level regulatory inquiries and provide interpretation of regulatory rules and guidelines to demonstrate compliance with state and federal requirements. ESSENTIAL FUNCTIONS: Provide interpretation of regulations and regulatory rules/guidelines to ensure compliance with state and federal requirements. Review and analyze all data received to generate comprehensive written responses to the originating party. Strategize with Legal and Compliance as needed to identify the best response to the complaint. Maintain positive, responsive, respectful relationships with all regulators. Occasional external contact with Regulatory Agency Investigators. Identifies potential volatile activity by gathering and analyzing regulated organizational data. Research, resolve and respond to written and telephone inquiries received....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying and verifying the needs of business or user. The incumbent is accountable for the gathering and synthesizing of business requirements for moderate complexity software, systems, processes and/or services and translates them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as a strategic conduit between the business area and the technical or software development team through which requirements flow. ESSENTIAL FUNCTIONS: Interprets business needs and issues by gathering, eliciting, creating, analyzing, documenting and validating the Business areas user and/or technical...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The purpose of the Lead Data Analyst, Pharmacy is to execute pharmacy business objectives with data and ensure alignment with the goals of Pharmacy and the overall vision of the company. The individual leads the design, development, and delivery of analytics solutions by defining data requirements, analytical approaches, reporting processes, and governance practices needed to address current and future analytics needs of the pharmacy business. This role provides thought leadership and serves as a subject matter expert (SME) in selecting and applying appropriate analytical methods and in translating complex analyses into clear, actionable insights for pharmacy SMEs, business leaders, and executive audiences. ESSENTIAL FUNCTIONS: Develop and maintain recurring reporting, executive-ready dashboards, and data presentations that support day-to-day pharmacy operations, key reporting milestones, and...

Aledade Join Aledade as a Practice Transformation Specialist (PTS) and personally make an impact on patient care. Practice Transformation Specialists are HQ’s most direct interface with providers and can glean valuable insight into our partner practice’s happiness and needs. A successful PTS is passionate about population health, and highly mission oriented around providing better care to patients while reducing costs. At Aledade, a PTS can impact the health of their community by transforming one practice at a time. Please note: candidates must be based in southern Maryland to be considered. Primary Duties: Direct Practice Support: Implement products and execute ACO initiatives with direction from Market Leadership. Accountable for implementing and supporting wellness visits, transitions of care, active management and ensuring practices meet goals set forth in mutually developed Practice Transformation Plans. ACO Training & Development: Work to assist...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This RN position supports line of business. Under minimal supervision, the Care Manager researches and analyzes members' 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 cost-effective outcomes. We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with members, family and providers to develop a comprehensive plan of care to address the member's needs at...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Manager, Technology Operations Center (TOC) is a hands-on technical leader responsible for operating and evolving a modern, cloud-first Technology Operations Center. This role owns Major Incident Management, Event Management, and enterprise monitoring and observability, supporting a large-scale Azure-based application and infrastructure ecosystem. The role is deeply aligned to ITIL v4 processes, Site Reliability Engineering (SRE) principles, and AI-driven operations, leveraging Dynatrace as the primary observability platform and ServiceNow as the ITSM system of record. The successful candidate will drive measurable improvements in service reliability, incident response, and operational automation while ensuring technology services meet the high availability standards required in health care insurance. ESSENTIAL FUNCTIONS: Lead the technical and operational execution of the Technology Operations...

CareFirst BlueCross BlueShield Resp & Qualifications 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. PURPOSE: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Marketing Technology & Insights Intern will support Marketing Technology (MarTech) initiatives focused on data strategy and platform enablement, while also assisting with enterprise survey research efforts led by the Insights team. Approximately 75% of this role will focus on MarTech responsibilities, including marketing systems, data flows, and platform evaluation. The remaining 25% will support survey research initiatives that inform marketing, experience, and business decisions across audiences. This is a year-round internship opportunity. We are looking for students who can commit to our work up to 15-20 hours per week during the academic year in the Fall/Spring and 35-40 hours per week during the Summer. The start date for the internship will be May 18th or June 1st. ESSENTIAL FUNCTIONS: 75% Marketing Technology (Data Strategy & Platform Enablement) Support marketing data...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Digital Marketing Project Manager Provider & Member Engagement leads the planning, execution, and optimization of digital communications across email, web, SMS, and mobile-first channels. This role manages campaigns that support both member and provider audiences, ensuring timely, compliant, and engaging communications that align with organizational goals and customer experience strategies. ESSENTIAL FUNCTIONS: Manage end-to-end project delivery for mobile engagement/SMS, email, and web campaigns targeting both member and provider audiences. Develop project plans, timelines, budgets, and resource allocations for lifecycle, operational, and promotional communications. Coordinate with cross-functional teams including marketing, provider relations, business areas, clinical teams, compliance, analytics, product, and IT. Oversee campaign workflows from intake and strategy through build,...

CareFirst BlueCross BlueShield Resp & Qualifications MD-DC-Northern VA 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 cost-effective outcomes. This position will support the Federal Employee Program line of business. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington DC metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with members, family and providers...

CareFirst BlueCross BlueShield Resp & Qualifications Maryland/ DC/ Northern VA 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 cost-effective outcomes. This position will support the Federal Employee Program line of business. We are looking for an experienced clinician to work remotely from within the greater Baltimore/Washington DC metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs complex analysis, design, development, automated unit and integration testing, and debugging of computer software ranging from operating system architecture integration and software design to selection of computer systems, language, and/or equipment. Designs, codes, tests, develops, and documents application programs for computer systems. Works with end-users and project stakeholders to define system scope and objectives. Manages modifications to and maintenance of operational programs and procedures. Leads stakeholder and product owner meetings to define software requirements and creates highly complex systems. Acts as a mentor to junior engineers. ESSENTIAL FUNCTIONS: Lead a team of software engineers in the design, development, and implementation of multiple applications. Performs and leads the detail technical design, coding, code review and testing of new applications and enhancements of...