Senior Project Manager, Clinical Programs

CareFirst BlueCross BlueShield - Baltimore, MD

Resp & Qualifications

The Senior Project Manager, Clinical Programs, functions within a dynamic division charged with improving the quality and experience of care while reducing cost via a continuum of care support programs. The incumbent supports the successful implementation and ongoing operation on a day to day basis of one or more care support programs that span organizational boundaries. He/she serves as primary organizational liaison with external vendor partners and managing the contractual relationship. Maintains a reporting system on the program’s operational, clinical and cost of care metrics reviewed regularly by senior leadership. Shepherds the measurement and assessment process with the I.T and other internal stakeholders to enable increased visibility of programmatic impact.
Responsible for execution/delivery projects within assigned clinical program(s). Coordinates and is responsible for day –to- day implementation, vendor management, coordination with SBUs and closely coordinates with management of other clinical programs. Ensures alignment with the overall corporate vision and goals by focusing on compliance, procedures and monitoring/control to achieve program goals. Works closely with the Division’s clinical leadership on the design, implementation and oversight of the program. Presents program updates to leadership on a routine basis. Assists in the development of new care support programs, consistent with Medical Affair’s Divisional Plan.

ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to, the following:

Responsible for supporting the end to end process of implementing clinical programs, monitoring Service Level Agreements with providers/external vendors within the clinical programs, and ensuring smooth operations between CareFirst and the provider/vendor partner. Serves as primary operational liaison with vendor partners; manages the contractual relationship with vendor partners including pricing, performance, contract terms and other key elements.

Participates in and supports the process of contracting, rate negotiations with vendors.

Coordinates all go-live activities to ensure that all parties are supported and assisted.

  • Acts as “go-to” person for tracking, analyzing and ensuring resolution of system and/or process based issues in the initial go-live phase.
Trouble shoots barriers to both day-to-day and systemic issues. Ensures that provider/external vendor provides services in accordance with SLAs.

  • Addresses escalated service issues, including onsite face to face meetings with executives to ensure the provider/external vendor resolves ongoing issues in acceptable long term solutions.
Develops and maintains a reporting system on clinical program’s operational, clinical, and cost of care metrics and facilitates communication between all key Medical Affairs groups and the stakeholder community

  • Evaluates complex data findings, interprets data and provides analytical commentaries to explain or highlight significant findings to drive operational performance.
  • Ensures that operational metrics include the performance of vendor partner’s adherence to program guidelines including the integration with other clinical programs.
Collaborates with a named Clinical Lead and a variety of stakeholders with the Medical Affairs division (as well as key partners internally and externally) for the purpose of supporting clinical programs and other key initiatives and projects; integrates activities with business units and Medical Affairs departments to ensure the successful implementation and operationalization of clinical projects/programs. Performs the high level tasks associated with general Program/Project Management:

  • Supports the full project management life cycle for the implementation of highly complex, large scale, strategic clinical programs initiatives.
  • Implements policies, work flows, business and system monitors and controls to ensure the successful management and reporting of the majority of the clinical programs utilized by all care management and care coordination areas across Medical Affairs.
  • Oversees the impacts and interdependencies between various complex work streams and works to ensure initiatives meet the goals and objectives of the Medical Affairs division. Perceived by peers and executive team as a leader.
  • Provides both verbal and written communications regarding project status, risks, issues, and makes recommendations on projects.
  • Manages all aspects of the project/program management of this initiative, which may include: cost benefit analysis, work plans, functional and technical designs, construction, testing, implementation and ongoing monitoring of vendor Service Level Agreements. Ensures efficient and high quality installation of new programs and services, and monitors all aspects of implementing projects.
  • Works with the Business areas in the operational readiness activities providing support and coordination to ensure adoption of new systems and business processes in the CareFirst environment.
  • Evaluates complex situations accurately and identifies viable solutions that create successful outcomes for the customer.
  • Develops and maintains “lessons-learned” inputs in the project repository for utilization on future projects.
  • Proactively identifies risks and opportunities of both business and technical plans.
QUALIFICATION REQUIREMENTS:Required Experience/Skills/Abilities:
Bachelor’s degree in HealthCare Management, Business, or a related field. In lieu of Bachelor’s degree, must have 4 years related experience.

In addition, must have:
  • 3-5 years of project management and/or consulting experience in healthcare or related environment.
  • Experience in new program development.
  • Exceptional project management skills, effectively arranging resources and managing multiple small to large projects in a cross-functional environment.
  • Working knowledge of Systems Development Lifecycle.
  • Ability to act as project lead across dynamic, energized, and highly creative multidiscipline high-performance work teams in learning and applying new skills/techniques to respond to business needs.
  • Ability to effectively adapt to rapidly changing technology and apply it to business needs.
  • Expert ability to synthesize complex data and analysis into clear, concise, executive-level presentations that frame decision options concisely. Experience in executive level reporting on strategic initiatives, developing and delivering effective executive presentations.
  • Strong teamwork and interpersonal skills, with the ability to communicate and persuade customers, employees, and management at all levels and thrive in a cross-functional environment.
  • Excellent oral and written communications; an ability to present and discuss technical information in a way that establishes rapport, persuades others, and gains understanding.
  • Excellent communication skills are required to persuade, gain cooperation, provide formal presentations to various sized groups and to reach consensus and resolve conflict. Strong consulting skills working with all level within the organization and across external business partners to gain understanding and buy-in
  • Strong business planning and organizational skills.
  • Advanced planning, organization, analytics and business acumen are required to understand and present the implications of various decisions.
  • Ability to analyze project needs and determine resources needed to meet objectives.
  • Strong analytical, problem-solving, and conceptual skills.
  • Demonstrated proficiency with multiple reporting applications and tools, including MS Excel, Access, Word, PPT and Project.
  • Experience in vendor management, including development of RFPs and SOWs and the tracking and monitoring of service level agreements.
  • Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  • High level understanding of delivery system and policy and business environment to improve quality of care and reduce costs.
  • Master’s degree in Healthcare, Business or Technology related field.
  • Prior health insurance industry experience.
  • Project Management certificate (PMP) from the Project Management Institute (PMI).
  • Thorough knowledge and understanding of the company’s business practices and direction, busi¬ness principles, and business processes, plus familiarity with the company’s products and resources.


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Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 10/12/2019

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted. Must be able to drive independently to vendor locations for site visits and/or business meetings.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship