Resp & Qualifications

PURPOSE: 
This position will manage all key aspects of systems operations, including configuration setup, system and integration testing, production issues triage and resolution, and interface monitoring/ resolution four our clinical platform, Guiding Care, supporting Care Management, Utilization Management, and Appeals and Grievance, ensuring system/product alignment with CareFirst Plan requirements across all health services functions across all lines of business. The position will also support the operations team in defining and building reports and queries for key operational data. The Manager, Systems Operations is critical in ensuring systems optimization and availability in a mission-critical, high availability environment. 

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 CareFirst location periodically for meetings, training, and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Manages the team's leadership and planning efforts. Hires, motivates, coaches, counsels, and develops team members and ensures that staff has appropriate tools and training. Evaluates performance of each team member, generates performance plans and sets goals within the context of the corporate policy. Ensures that team members are kept abreast of all relevant standards and methods. Develops and manages the team's budget.
  
  
  
• Ensures successful completion of day-to-day changes, corporate initiatives, and other projects by managing team and/or matrixed resources to ensure effective Systems Development Life Cycle (SDLC) activities spanning request analysis, requirements or specifications documentation, acceptance testing, development and maintenance of operating procedures operations support, and implementation impact assessment.
  
  
  
• Ensures successful completion of other tasks, such as day-to day enhancements, auth transmission error handling, updating user documentation, standard operating procedures, functional testing, and issue resolution reports. Ensures development and oversees use of team controls and processes for production systems support and monitoring, which includes issue analysis, tracking, and resolution. Document operational systems processes and work with peer managers to create process documents. prepares day to day operations performance reports by collecting, analyzing and summarizing data and trends. Working knowledge of Tableau, Power BI and OneStop/ Service Now ticketing system required.
  
  
  
• Directs and participates in planning sessions to ensure that the teams' operations and long-range goals are coordinated with other department staff, IT, and clients. Develops and/or assists with the development of project management plans for day-to-day changes, corporate initiatives, and other projects. Provides resource estimates, timeframes, guides cost/benefit ROI business cases, and assists with the development of budgets for initiative projects. Oversees corporate processes for systems change management, spanning request submission, review, validation, prioritization, scheduling, and status reporting.

SUPERVISORY RESPONSIBILITY:
This position manages people.


QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Administration 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: 5 years Business Analysis experience.1 year supervisory or progressive leadership experience.

Preferred Qualifications:

• Familiarity with health insurance operations and/or healthcare systems; direct experience with Guiding Care platform required.
• Progressive experience in system operations with time spent driving delivery partner led functional testing team.
• Proficient knowledge of Guiding Care platform including user workflows for internal users and external providers.

Knowledge, Skills and Abilities (KSAs)

• Demonstrated in-depth experience with technologies, systems, and business processes supported by the department (e.g., claims processing, enrollment and billing, financial, etc.).
• Experience in industry best practices for project management (including resource estimating, tracking, and metrics), business/systems analysis, and software testing.   Demonstrated competence with full software development project life cycle.
• Must be able to evaluate demands on a timely basis and distribute resources effectively, establish and manage multiple priorities, and respond appropriately to unplanned events/projects.
• Excellent written and verbal communication, interpersonal, analytical, and problem-solving skills.
• Must have the ability to negotiate and manage customer relationships and expectations.
  
  

Salary Range: $116,240 - $215,771

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Guiding Care Product Management

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.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

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.

PHYSICAL DEMANDS:

The associate 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 associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

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

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