66 services operations manager jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an experienced Care Manager to support our Maryland Medicare enrollees. 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. We are looking for an experienced professional 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. Bi-lingual / Spanish speaking a plus! ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and...

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: Responsible for planning and managing day to day activities regarding network development. Responsibilities include provider recruiting/contracting for commercial business and government programs, new networks, coordination with the Payment and Practice Transformation Team for value-based contracts, managing department-related RFP responses, tracking hospital-based practices and provider resignations, maintenance of participation agreements, reporting departmental metrics and overall management of all non-standard contract negotiations including single case...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Join our team to lead the creation of CareFirsts next-generation Integration Platform, seamlessly blending API-first design with a product-based approach to advance our cloud-native strategy. Play a pivotal role in transforming how we operate, enabling faster innovation, streamlined execution, and cost-effective solutions that scale across our Enterprise Portfolio. CareFirst is undertaking a digital transformation which requires enterprise agility paired with the retooling of our technology stack to speed-up delivery and to expand our reach. The Digital Factory organization is leading this charge by advancing our Scaled Agile Framework (SAFe) ways of working across the organization. To drive this transformation, the Platform Engineering Manager is a key role within the Integration & Interoperability team that builds technical depth, expertise, and resource management within the Nexus platform....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages end-to-end oversight of the Stored Information Retrieval (SIR) system and related operational processes including front-end mail room services, document scanning and digital record storage related to member and provider submitted paper claims, correspondence, appeals, finance checks, enrollment forms and provider credentialing forms. 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, customer satisfaction, and organizational metrics and performance. Takes full ownership of all components of program from day to day tasks to building road maps, driving strategy and leading organization wide initiatives...

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...

CareFirst BlueCross BlueShield Resp & Qualifications Join our Platform team to play a key role in shaping CareFirsts next-generation Integration Platform, with a strong emphasis on MuleSoft as a cornerstone of our future-state architecture. This role drives innovation, defines technical strategy, and champions developer enablement to accelerate adoption of an API-first, product-based integration approach. By leveraging MuleSofts platform capabilities, you will help streamline execution, enable reusability, and deliver scalable, cost-effective solutions that power our enterprise portfolio. CareFirst is undergoing a digital transformation that demands enterprise agility and a modernized technology stack to increase speed-to-market and broaden our impact. The Integration & Interoperability organization is at the forefront of this shift, advancing Scaled Agile Framework (SAFe) practices across the enterprise. As a Sr. Platform Engineer, you will lead MuleSoft platform...

CareFirst BlueCross BlueShield Resp & 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 and CareFirst's accreditation standards. We are looking for an experienced people 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 a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Supervise the daily operations of the UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensure appropriate usage of resources in order to...

CareFirst BlueCross BlueShield Resp & 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 and CareFirst's accreditation standards. We are looking for an experienced clinical 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 a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Supervise the daily operations of the UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensure appropriate usage of resources in order to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and Implements strategy for the company's product line and is responsible for the product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product vision. Working with Product Owners, IT, and other stakeholders to prioritize product and customer requirements against the business strategy, product roadmap, and value drivers. Partners closely with engineering to ensure we deliver winning products that meet CareFirst and member needs. Oversees the product roadmap development process ensuring it includes the UX, design teams, operations managers, engineering managers, and finance teams. Confirms project deadlines with support from the product owners and delivery team. To ensure the product development stages meet internal and external stakeholders. expectations. Also, provide timely and accurate communication...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles embedded at a partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality of care and manage healthcare costs. The incumbent will function as a liaison working onsite at partner hospitals up to 5 days a week. Based on hospital assignments and admission volumes on a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole discretion.The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Behavioral Health Care Manager will support the Maryland Dual Eligible Special Needs Plan (MD DSNP). 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. We are looking for an experienced professional 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 member, family and providers to develop a...

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 member, family and providers to develop...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Director, Data Transformation & Portfolio Management, will direct the development and implementation of high-level Data & Analytics strategies and oversee complex organizational change initiatives, involving technology, people, and processes. This role also oversees the portfolio of enterprise D&A initiatives through a scaled agile operating model. ESSENTIAL FUNCTIONS: Strategic Leadership Define and evolve the D&A transformation roadmap. Establish governance, KPIs, and reporting. Oversee major initiatives and advise senior leadership. Portfolio & Agile Oversight Manage data portfolio and scaled agile operations across nine domains. Drive workforce planning, talent alignment, and capacity forecasting. Resource & Budget Optimization Develop resource allocation strategies. Monitor $60M+ budget, ensuring financial rigor and cost-effective delivery in...

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: Responsible for the daily management, coaching, and development of the Provider Relations team including oversight of department operations, promoting quality service, strengthening relationships through proactive training, education, communication, and ensuring complex problem resolution to all network providers in Maryland, DC, Northern Virginia and continuous counties. ESSENTIAL FUNCTIONS: Responsible for improving provider experience; anticipates provider issues and develops a plan to reduce concerns through better alternatives; responsible for issue...

Transamerica Job Family Account / Relationship Management About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and...

Comcast Comcast brings together the best in media and technology. We drive innovation to create the world's best entertainment and online experiences. As a Fortune 50 leader, we set the pace in a variety of innovative and fascinating businesses and create career opportunities across a wide range of locations and disciplines. We are at the forefront of change and move at an amazing pace, thanks to our remarkable people, who bring cutting-edge products and services to life for millions of customers every day. If you share in our passion for teamwork, our vision to revolutionize industries and our goal to lead the future in media and technology, we want you to fast-forward your career at Comcast. Job Summary Salary is $17.00/hour Base + $16,000 Annual Targeted Commission, averaging $24.69+ Hourly Responsible for assisting and consulting with customers on our products and services by utilizing knowledge, skills and technology to achieve a world class sales and service experience...

Transamerica Job Family Sales Support / Operations About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: Joining the American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When you choose to be a force for good, you'll have mentors who empower your growth along a purposeful...

Transamerica Job Family Regulatory Compliance About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of...