51 healthcare jobs found in Baltimore

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 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...

Creative Circle Associate Director, Digital Product Manager - Insurance (Optional Products) Position Overview Our client is a well-established consumer financial services company undergoing a significant digital transformation. They are expanding their Digital Product organization to build connected, customer-centric experiences across lending, credit, insurance, and financial wellness. The Associate Director, Digital Product Manager is a senior individual contributor role within the Digital Product Team, responsible for defining and driving the digital strategy for the organization's optional insurance products. This role does not manage a team and does not have a dedicated scrum team; instead, it requires a highly experienced product leader who can work across domains and teams, scope new initiatives, and influence delivery through strong product thinking and stakeholder alignment. This role owns the end-to-end digital insurance experience across web and mobile, with a...

Creative Circle Product Operations Lead Position Overview Our client is a well-established consumer financial services company undergoing a large-scale digital and product transformation. They are building new ways of working across Product, Design, Engineering, and Go-to-Market teams and are hiring a Product Operations Lead to help scale product excellence and measurable impact across the organization. This is a hybrid opportunity, onsite Tuesday, Wednesday, and Thursday in New York, NY, Wilmington, DE, Baltimore, MD, or Dallas/Irving, TX. The Product Operations Lead will focus on building the systems, partnerships, and visibility that enable teams to consistently deliver high-quality product outcomes that drive customer retention and growth. This role is highly hands-on and fluid-one day focused on documentation and workflows, another on training and enablement, and another on experimenting with GenAI tools to redefine how Product, Design, and Engineering operate in an...

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: The Data Analytics Intern role exists as a hiring strategy to bring in students enrolled in an accredited college or university who are pursuing at least a Bachelors degree in analytical and/or data visualization related fields to learn the business and technical side of healthcare from the ground up. Data and Analytics creates cutting edge analytic tools/visualizations to drive insights and faster decision making within the organization and provides critical support for key corporate initiatives. This role will require interaction with project stakeholders and business partners within the organization. This position will use analytically derived insights to develop and test solutions that enhance consumer engagement, improve health outcomes and reduce health care costs. This is a fast-paced, collaborative, and iterative environment requiring quick learning, agility and flexibility. This is a Year-Round...

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: This role is accountable for directing all aspects related to the monitoring of performance under the Medicaid contract and regulatory requirements and the overall state of compliance for Medicaid and Medicaid products. Reporting to the CEO, Plan Board of Directors, and Corporate Compliance Officer, the incumbent works closely with operational teams, Corporate Compliance, Mandates and Legal departments to resolve complex issues with inter-related legal and Medicaid compliance aspects. ESSENTIAL FUNCTIONS: Direct accountability for establishing an effective compliance program based on the seven core elements of compliance. Directs the activities related to the design, development, implementation and maintenance of compliance programs across all major functional areas and vendors for Medicaid within the division. Ensures internal departments understand and implement CMS and applicable state rules,...

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 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: The main purpose of a data analyst is to find meaning in data as a thought leader so that the derived knowledge can be used to make informed decisions and assist the organization in making better business decisions. ESSENTIAL FUNCTIONS: Engages in data exploration using various programming languages (reading and writing code), requiring advanced knowledge of multiple database structures Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations Serve as an expert resource supporting data questions and issues from...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE The Senior Analyst, FP&A Workforce Planning & Operations Analytics develops longrange operational forecasts, workforce capacity models, and analytical tools that guide staffing, budgeting, and servicelevel decisions. The role combines financial planning, data analytics, and workforce modeling to deliver clear insights that optimize staffing and labor costs. This position is ideal for a datasavvy analyst looking to deepen FP&A and operational strategy experience while applying advanced technical skills (SQL, Excel, Python, Power BI, MS Fabric/Azure) ESSENTIAL FUNCTIONS: Forecasting & Demand Modeling: Develop driver-based demand forecasts using enrollment, product changes, seasonality, regulatory shifts, digital adoption, and other operational trends/drivers. Translate business growth (membership, product launches, group movement) into actionable operational workload across all teams in...

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,...

Rentokil North America Benefits Start Day 1 for Full-Time Colleagues - No Waiting Period! For more information about our benefits, see below! We are proud to be a member of the Rentokil family of companies, the global leader in Pest Control and other services across more than 90 countries. We pride ourselves on being a trusted partner to many of the world's leading brands and serve consumer and business customers across multiple industries. We are extremely proud of our legacy of excellence and constantly work to fulfill our mission to "protect people, enhance lives, and preserve the planet." What do our Regional Account Executives do? As a Regional Account Executive your assignment will include prospecting for new clients with the objective of selling our industry leading pest elimination solutions. The Regional Account Executive will be calling on a full spectrum of market segments including hospitality, food & beverage processing, healthcare, retail, and...

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: This is a Year-Round Internship. We are looking for students who can commit to work up to 15-20 hours per week during regular business hours (M-F 8-5PM) for the academic year in the Fall/Spring and 35-40 hours per week during the summer. Motivated and detailed CRM intern to join the Large Group Commercial Market Account Management Team. This internship will get hands on experience in the health insurance industry, supporting our team in managing client relationships, driving sales initiatives, and contributing to the growth of our business. PRINCIPLE ACCOUNTABILITIES: Support the team in addressing client inquiries and ensuring client satisfactionAssist in researching client inquiriesDevelop an understanding of the health insurance industry including benefit & mandate requirements for fully insured, self-insured, and Medicare Advantage groupsReview and analyze benefit plan...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and Implements strategy for the Experience and Digital Marketing 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre claim medical review for Commercial and Federal lines of business. This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. This role will also understand the merits of legal or accreditation actions. We are looking for an experienced RN 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: Receives, researches, reviews and analyzes...