Carefirst Jobs

Resp Qualifications PURPOSE: Manages end-to-end oversight of business initiatives. Drives teams and internal projects to maintain and enhance program performance over... Read More

Resp Qualifications PURPOSE: Responsible for evaluating applicant situation and circumstances; studying rate tables, codes, computer records and references, and other... Read More

Resp Qualifications This position is remote but candidate must live in the DC/VA/MD region to attend local events. (Primarily in DC and VA) PURPOSE: Develops relationships... Read More

Resp Qualifications PURPOSE: The External Affairs Manager is responsible for developing and enhancing relationships with government officials in their respective... Read More

Resp Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse... Read More

Resp Qualifications PURPOSE: Leads a cross functional team, guiding them on how to use Agile, Scrum and Lean values/practices through servant leadership. Creates and... Read More

Resp Qualifications PURPOSE: The Specialist, Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations... Read More

Resp Qualifications PURPOSE: The Senior Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or... Read More

Resp Qualifications PURPOSE: The Care Management Supervisor supervises, directs and coordinates the activities of Care Managers. Develops and reviews Care Management... Read More

Resp Qualifications PURPOSE: Triage and develops case leads for the department, using various data sources and employing statistical analysis and reporting skills.... Read More

Resp Qualifications PURPOSE: Under minimal supervision, the Oncology Commercial Care Manager researches and analyzes an Oncology member's medical and behavioral health... Read More

Resp Qualifications PURPOSE: You will be responsible for managing CareFirsts Cybersecurity engineering team, with a strong emphasis on cloud, identity, and infrastructure... Read More

Resp Qualifications PURPOSE: Provides Machine Learning service to BCBS plans to improve claim processing, provider prediction, and automation that reducing human... Read More

Resp Qualifications PURPOSE: The Senior Business Consultant (Business Readiness) provides expertise in tailored, strategic, and critical work to help design, launch, and... Read More

Resp Qualifications PURPOSE: Ensures the stability, integrity and efficient operation of the organization information systems that support organizational functions. This... Read More

Resp Qualifications PURPOSE: The Medical Director oversees all activities of utilization review, care management and quality to determine the medical effectiveness of... Read More

Resp Qualifications PURPOSE: The Senior Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or... Read More

Resp Qualifications PURPOSE: The Quality Assurance Specialist I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and... Read More

Resp Qualifications This position is HYBRID and requires frequent travel into the Maryland office; therefore, candidates must live within driving distance. PURPOSE:... Read More