Manages end-to-end oversight of business initiatives. 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. This specific role will create a comprehensive comparison of the local and national scoring methodologies. Create a plan for landing BCBSA national datasets into our data tables so that it can be analyzed and incorporated with our current in-house evaluations. Create of a project plan with approval from MIA for full NCQA approval of our local scores to enable publishing them on member-facing materials. Integrate provider performance rating data into our provider data systems to enable publishing on CareFirst provider directory, other member facing materials, network generation/tiering, and referral steerage via internal teams. Create evaluation of Clinical Programs (Care Management, Utilization Management, Specialty Programs) to convey the successes or shortcomings.

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.

ESSENTIAL FUNCTIONS:

• Evaluates healthcare analytics support to generate insights for healthcare solutions. Manages complex program(s) or strategic initiatives that span organizational boundaries and have a significant legal and/or financial impact to CareFirst Business. Identifies process improvement opportunities and takes action to implement enhancements to maximize outcomes and growth. Creation of a comprehensive comparison of the local and national scoring methodology (group vs. NPI level, specialty availability, quality and cost measurement, etc) with a plan for landing all provider evaluation data for analysis and integration to enable publishing on provider directory and member facing materials, network generation/tiering, and referral steerage via internal teams (ie. Care management, customer service, etc) and network providers (ie. SearchLight reporting).

• Engages with business leads as a trusted thought partner to perform both proactive and reactive analysis for key stakeholders and derives insights between key metrics and their drivers. Coordinates with internal and external stakeholders to launch, maintain, and enhance complex program(s). Provides direction and motivation to project teams in a matrixed environment. Drives outcomes by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors.

• Researches meaningful reports and analysis for health care system entities and presents on findings. Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations. Serve as consultant and expert in data insights and    infrastructure within Health Services and other department leadership. Research and analyze data flow across complex data ecosystem including operational and analytical data platforms. Integrate internal and external datasets to enhance analytics such as data from  Socially Determined, Blue Health Intelligence, and other purchased or publicly available datasets.

• Creates effective key performance indicators and balanced scorecards that provide improved decision- making. Measures, evaluates and reports on program(s) performance related to ROI, customer satisfaction, and other organizational metrics. Effectively forecasts and manages people, process and technology related resources to ensure successful achievement of corporate goals. Leads the generation of regular book of statistics on clinical program and network performance for use in market-facing materials and sales enablement activities such as RFP responses.

• Builds infrastructure that supports analytical rigor and develops models and tools that drive healthcare strategy.

• Uses business analytics to anticipate future needs of the healthcare organization.

• Leverages data to address business challenges using data analytics. Interprets results of analyses, identifies trends, and develops alternatives to support business objectives. Lead in the design, development, validation and delivery of data to provide insight into business decisions. Collaborate with the rest of the Health Services team and other teams across the company including Sales, Strategy and Planning, etc to draw connections across programs and projects. Assist in production of value statements as needed to bring clinical solutions to market in support of sales growth.

• Seen a 'go-to' person and mentor for departmental staff.

SUPERVISORY RESPONSIBILITY:

This position has no direct reports, however, may informally lead teams in a matrix environment.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Statistics, Mathematics, BIT or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 8 years experience with business intelligence tools, data analytics and/or database management systems.

Preferred Qualifications: SQL

Knowledge, Skills and Abilities (KSAs)

• Ability to translate technical complexities to key business stakeholders. 

• Ability to learn and understand all areas of operations within the organization. 

• Ability to think creatively and critically and thrive in a fast-paced environment.

• Knowledge of business intelligence software, such as PowerBI, Qlik, or Tableau. 

• Use of Microsoft Applications.

• Quantitative, analytical and problem-solving skills. 

• Ability to learn quickly and take direction. 

• Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.

• Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.

Licenses/Certifications Preferred Upon Hire:

• Certified Business Intelligence Professional  

• Certified Business Analysis Professional (CBAP)