Clinical Risk Manager Jobs in Towson, MD (NOW HIRING)

Purpose of the Manager, Data Analytics is to execute business objectives with the Health Services' Risk Adjustment team. This position leads the analysis, reporting, and performance monitoring activities that support the organization's Risk Adjustment programs. The role is responsible for directing the development of trusted data assets, producing actionable reporting and insights, and leveraging advanced analytics to improve program outcomes through collaboration with clinical, operational, financial, and technology teams. Responsibilities include oversight of key performance metrics, risk score forecasting, member and provider targeting strategies, dashboard and reporting solutions, CMS, HHS, and MDH reconciliation activities, and ad hoc analyses to identify opportunities for enhanced program performance and operational efficiency. The ideal candidate will possess a strong understanding of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies, along with a commitment to data governance, compliance, and analytical excellence. Individual will organize the technology, processes and financial resources necessary to address the current and future analytics needs of the business. Provides thought leadership and acts as a subject matter expert in the designing and recommending of appropriate analytical approaches and methodologies. Provides management responsibility into data-driven insights that inform the business's strategic direction.

This role requires candidates to be located in the Maryland, Washington, DC, or Northern Virginia (DMV) area who are willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and at least two days a week at a CareFirst location based on business needs and work activities/deliverables that week.

• Manage a team with a focus on the development of analytics capabilities across the company, including self-service capabilities through technology implementation, best practices and training. Ensure team members serve as a trusted advisor to clients on analytics and data.
• Interpret statistical analyses and help clients derive meaning from them.
• Develop and deliver presentations and reports of analytic findings
• Develop hypotheses and research questions to address clients' needs. Conduct a wide range of quantitative, qualitative, and mixed-methods analyses to develop required reporting.
• Develop analytic frameworks and select appropriate analytic methods needed for all deliverables.
• Partner with stakeholders to understand data requirements and with internal and/or external resources to develop tools and services such as segmentation, modeling, dashboard development, decision aids, and business case analysis to support the Risk Adjustment Team.
• Uses and creates multiple data sets to create reports and data presentations, and eventually creating data dashboards, for leadership and managerial use.

This position manages people.

Education Level: Bachelor's Degree in Computer Science, Information Systems 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.

• Data Management\Certified Analytics Professional (CAP)or
• Data Management\MapR Certified Data Analyst

5 years Progressive experience relating to data analytics/data analysis

1 year Supervisory experience or demonstrated progressive experience.

• Master's Degree.
• Conceptual data and cloud architecture - understands major native data components in Azure and/or AWS and there relationships and use cases.
• Mastery of relational database theory include SQL and at least one major RDBMS.
• Well versed in Big Data scenarios and applications.
• Experience with multiple analytics delivery tools, methods, and platforms including PowerBI, Fabric, SSMS, and/or Python.
• Understanding of Advanced Analytics use cases and the applications of AI/ML for predictive analytics.

• Strong quantitative and qualitative skills.
• Knowledge and understanding of analytical tools, such as SAS, Excel, SQL.
• Excellent communication skills both written and verbal.
• Ability to train others.
• 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.

Salary Range: $127,360 - $236,412

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 responsibilities 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).

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

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 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.

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

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