77 associate director jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Be part of our progressive Health Services team at CareFirst. In collaboration with Medical Directors and other clinicians, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted standard of medical practice. 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: Performs in-depth research on medical topics identified in existing medical policies and operating procedures scheduled for revision or updates based upon changes in the standard of care. Evaluates current peer-reviewed articles and other literature to determine its appropriateness of...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position serves as a key liaison between the Cost Accounting/Finance function and the other divisions throughout the organization. This role is responsible for analyzing data, performs various Cost Accounting functions requiring knowledge of the theory and practice of recording, classifying, examining, and analyzing corporate data and financial transactions of the organization. This position also provides financial support to the business, through analysis of cost accounting documents and results; and interacts regularly with business owners, data suppliers, and other finance division teams. This role is responsible for optimizing accounting systems and processes, enhancing reporting capabilities and ensuring accurate and efficient financial operations. Additionally, this role helps prepare and produce statutory and financial reports for regulatory bodies and internal stakeholders, along with analyzing...

CareFirst BlueCross BlueShield Resp & 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. The critical responsibility will be the management of care delivery in a cost effective and quality assured system that will assist the organization to achieve its corporate mission of serving the health needs of members. ESSENTIAL FUNCTIONS: Ensure that the provision of health care service to the membership is compliant with the medical policies and standards. Participate in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals. Serves as key resource for network physicians for peer-to-peer case discussion. Provides clinical support for utilization review, care management and quality to determine the medical effectiveness of proposed...

CareFirst BlueCross BlueShield Resp & Qualifications Candidates must live in the MD/DC/VA surrounding areas in order to travel frequently into the offices and client meetings. PURPOSE: Are you ready to lead a dynamic team and drive strategic growth in the commercial market segment? As the Director of Commercial Accounts, you will provide visionary leadership to the 51-99 commercial Account Consultants, ensuring maximum customer retention and ancillary growth. This pivotal role involves overseeing, managing, and directing the team to boost sales volume for our commercial employers, while also contributing to the achievement of our corporate goals. ESSENTIAL FUNCTIONS: Team Leadership: Inspire and manage a talented team of Account Consultants, ensuring top-notch performance and professional development. Retention & Growth: Achieve retention, renewal, and financial goals for medical and specialty products within the 51-99 commercial segment....

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 The candidate's primary residence must be within the Prince George's County/Montgomery County/Washington DC or Northern Virginia metropolitan area. PURPOSE: The Inpatient Management Care Management Supervisor will direct and coordinate the activities of both telephonic and onsite Clinical Navigators embedded at or assigned to 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 initially support telephonic Clinical Navigators and as business needs evolve, 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Assistant General Counsel II provides a complete range of highly specialized legal services in support of the General Counsel, Deputy General Counsel, Director, Managing Assistant General Counsel, and executive management in the Division(s) to which the Assistant General Counsel is assigned, and may represent CareFirst, Inc., its subsidiaries, and/or affiliates ("the Corporation") in litigation brought by and or against it. The Senior position is expected to work independently and provide high-level executive support. This position will support the Company's care delivery operations, including comprehensive representation of various provider entities. ESSENTIAL FUNCTIONS: Legal Advice Provides written and oral advice directly to executive management and/or their designees in complex and rapidly evolving areas of the law. Analyzes and provides legal guidance on a wide range of regulatory,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted standard of medical practice. 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: Performs in-depth research on medical topics identified in existing medical policies and operating procedures scheduled for revision or updates based upon changes in the standard of care. Evaluates current peer-reviewed articles and other literature to determine its appropriateness of clinical guidance and mandated legislation in support of and inclusion in...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Broker Relations Manager's primary responsibility is to bring the value of CareFirst to the marketplace by engaging and working with CareFirst's distribution channel (brokers). This role combines strategic leadership with hands-on management to ensure brokers receive timely, accurate, and comprehensive assistance. The ideal candidate will foster a customer-centric culture while driving operational excellence and team development. ESSENTIAL FUNCTIONS: Broker Relationship Management Serve as the primary escalation point for complex broker inquiries and issues, ensuring timely and satisfactory resolution. Build and maintain strong relationships with key broker partners, full service producers and consultants, understanding their needs and business objectives. Monitor broker satisfaction metrics and implement strategies to improve service delivery and partner experience. Collaborate with sales...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers' reimbursement fee levels. The incumbent will work with various commercial and government program related fee schedules, develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports and fee disclosure related documents. Knowledge of Medicare or Medicare Advantage products preferred. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or...

Northrop Grumman RELOCATION ASSISTANCE: Relocation assistance may be availableCLEARANCE TYPE: SecretTRAVEL: Yes, 10% of the Time Description At Northrop Grumman, our employees have incredible opportunities to work on revolutionary systems that impact people's lives around the world today, and for generations to come. Our pioneering and inventive spirit has enabled us to be at the forefront of many technological advancements in our nation's history - from the first flight across the Atlantic Ocean, to stealth bombers, to landing on the moon. We look for people who have bold new ideas, courage and a pioneering spirit to join forces to invent the future, and have fun along the way. Our culture thrives on intellectual curiosity, cognitive diversity and bringing your whole self to work - and we have an insatiable drive to do what others think is impossible. Our employees are not only part of history, they're making history.At the heart of Defining Possible is our commitment to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Manger, Data Management is responsible for leading a team of technical data analysts with deep healthcare experience across multiple domains who support the data curation of complex data products and data transformation. This role combines technical and analytical expertise with leadership and critical thinking to develop high quality data assets that drive data drive decision making across the organization. ESSENTIAL FUNCTIONS: Data Management Oversight Leads the team in deep data exploration and analysis gaining domain expertise. Translate business rules into technical specifications to support data pipeline development. Manage data lifecycle processes including acquisition, storage, transformation, and archival serving has de-facto data product manager for the enterprise data warehouse. Manage Master Data Management process for several domains. Enforce data quality standards, metadata...

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 CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE Manages and supports the sales growth and retention of assigned Account Consultants for Mid-Market (51-99) market segments. Conducts sales and service to assigned accounts. Monitors the development and implementation of strategic long-term customer relationships. Achieves targeted Retention Sales goals for the unit. ESSENTIAL FUNCTIONS Develops account strategies in accordance with overall strategy. Works with the team and Brokers to maximize retention and growth. Manages the Renewal support/service functions essential to day-to-day account, service, productivity, implementation and retention. Develops account goals and business plan with customer. Conducts regular reviews of business performance, promotion strategies, and planograms. Forecasts, budgets, and tracks...

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 This role is a Hybrid position with 10-24 days per quarter in our Baltimore City, Columbia, MD or Washington DC office. PURPOSE: The Employee Relations Specialist partners with employees, managers and Human Resources Business Partners to investigate and bring resolution to employee relations issues that provide fair and consistent treatment to all employees, and in a manner consistent with the company's policies, procedures, and state and federal law. ESSENTIAL FUNCTIONS: Conducts basic/moderately complex HR investigations, including intake processes, investigation planning and interviews, recommendation and determination, and reporting/insights analysis. Communicates and updates status of investigations to relevant managers and HRBPs. Collects and maintains evidence, including testimonial and documentary evidence, for use in drawing investigative conclusions. Draft summary reports detailing findings resulting...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Provides leadership that drives strategic vision of the Company's financial systems, including the ERP and EPM systems and the suite of applications that connect to those. This role will work with the Finance and IT leadership teams and other business partners to develop and continually maintain an innovative future-state roadmap for financial systems and processes taking into account business priorities and strategic objectives. This role will collaborate with the leadership teams across the organization on applications strategy and in building out key capabilities and services to support the organization. Responsible for driving innovation in a fast-paced rapid growth environment, delivering software solutions that meet or exceed customer and stakeholder expectations in a manner that optimally leverages technology. ESSENTIAL FUNCTIONS: Responsibility for support and maintenance of our Finance...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Specialist, Account Installation II is responsible for the installation of more complex assigned accounts into core platforms and complimentary systems, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related administrative documents. Provide new hire support through training and pre-auditing as well as cross-training existing associates. ESSENTIAL FUNCTIONS: Perform installation of more complex assigned accounts, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. ESSENTIAL FUNCTIONS: Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government Program lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. 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: Prioritize, research and analyze all pertinent information in preparation of an appeal and/or grievance request. Access the appropriate database to implement accurate and timely entry of appeal, grievance, and/ or reconsideration correspondence and updates the appropriate referral...