Qureos Mentor

CareFirst BlueCross BlueShield

<div>Resp &amp; Qualifications
PURPOSE:
 
This position is responsible for managing a team of Sourcing Associates who perform daily activities within the purchasing process, serving as the primary interface with business owners and supplier representatives. This position is responsible leading the end-to-end sourcing process of lower complexity sourcing initiatives.
 
 
ESSENTIAL FUNCTIONS:<ul><li>
Oversees the end-to-end sourcing process for lower complexity sourcing initiatives and directs the day to day operations of a team of Sourcing Associates. Leads Stakeholder Engagement and Sourcing Initiatives. Works with business stakeholders and procurement management to frame and develop project objectives, requirements, and sourcing strategy prior to supplier engagement. This includes leading stakeholder engagement and sourcing initiatives, reviewing purchase requirements, developing sourcing strategy, supplier selection, supplier negotiations, and contract drafting, all in accordance with Corporate Purchasing Policies.
</li><li>For Sourcing events within scope, conducts negotiation and drafts contracts and purchase orders that accurately capture business, technical, and legal requirements (including contractual and purchase order documentation). Acts as liaison with business owner and supplier during negotiations. and works closely with legal and risk groups to ensure consistent communication and socialization of significant legal and risk issues throughout the negotiation process. Ensures and adheres to corporate purchasing policy directives and Federal Government regulation and ensures compliance with contractual requirements for the Federal Employee Program and other state and local contracts specifically related to MBE/WBE requirements and reporting.</li><li>
Develops key performance measures for chosen suppliers and negotiates on multiple variables to award longer-term strategic contracts that result in significant cost reduction and improved service levels. Analyzes and compares service and/or product offerings and specifications, investigates future renewal requirements and options, and resolves contract and invoice discrepancies. Manages existing contracts to anticipate and prepare for ongoing renewals. Provides other services related to the sourcing, contracting, and supplier management function as required.</li></ul>
SUPERVISORY RESPONSIBILITY: 
This position manages people. 
 
QUALIFICATIONS: 
 
Education Level: Bachelor's Degree in Business Administration or a relevant 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 in sourcing, procurement, or supplier development. 1 year supervisory or progressive leadership. 
 
Knowledge, Skills and Abilities (KSAs)<ul><li>
Ability to multi-task, manage multiple customer service demands from internal and external customers, prioritize and work in an extremely fast-paced environment.</li><li>
Excellent project &amp; time management skills including but not limited to risk assessment, workplan development and management.</li><li>
Ability to toggle between strategic and detail orientated thinking.</li><li>
Able to apply complex problem-solving abilities to achieve problem and process solutions.</li><li>
Proficient with Microsoft Windows and Office applications, particularly Microsoft Excel.</li><li>
Flexibility to adapt to dynamic and rapidly changing environments.</li><li>
Effective presentation, negotiation and influencing skills to interface with all levels of management and suppliers.</li><li>
Strong interpersonal communication and able to build relationships across the organization.</li><li>
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.
</li></ul>Salary Range: $108,480 - $201,366
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
Procurement &amp; Vendor 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
#LI-CB1</div>

Procurement Sourcing Manager (Hybrid)

<div>Resp &amp; Qualifications
PURPOSE:
The Inpatient Management Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team, including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to ensure a safe discharge. Based on hospital assignments and admissions volumes on a week-to-week basis, management may occasionally approve the Onsite Clinical Navigator to perform limited functions telephonically, at its sole discretion. The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary residence must be within Montgomery or Prince George's County area. Bilingual - fluent in Spanish a big plus! 
 
ESSENTIAL FUNCTIONS:<ul><li>
Works onsite at assigned hospital facility utilizing clinical expertise and critical thinking skills to analyze available clinical information, Electronic Medical Records (EMRs), benefit contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements to aid in determination of appropriateness and authorization of inpatient clinical services. Engages onsite with members, family and providers to identify key strategic interventions, discharge planning and coordination to address members medical, behavioral and/or social determinant of health needs to promote a safe transition to the appropriate level of care and/or home.</li><li>
Collaborates with CareFirst medical directors and participates in internal case rounds/discussions to determine appropriate course of action and level of care. While working onsite to make rounds with members and hospital staff, participates in clinical reviews to determine appropriate course of action and level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination.</li><li>
Makes referrals to other care management programs and vendors as appropriate for chronic, long term care coordination.</li><li>
Work collaboratively onsite with hospital teams to develop positive working relationships to decrease provider abrasion and improve member experience.</li></ul> 
QUALIFICATIONS:
Education Level: Bachelor's Degree in Nursing 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. 
 
Licenses/Certifications:<ul><li>
RN - Registered Nurse - State Licensure And/or Compact State Licensure.</li><li>
RN - Registered Nurse in MD, VA or Washington, DC Upon Hire Required.</li></ul>
Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review. 
 
Preferred Qualifications:<ul><li>
Knowledge and experience with MCG</li><li>
Experience working with Commercial and FEP employer group membership and</li><li>
Medicare/Medicaid enrollees and benefits contracts</li><li>
CCM certification</li><li>
MCG certification
</li></ul>Knowledge, Skills and Abilities (KSAs)<ul><li>
Strong interpersonal skills and the ability to engage in a member facing onsite in-person environment while at the same time building relationships and partnerships with hospital care team and alternative care deliver partners to meet member/enrollee needs.</li><li>
Strong clinical documentation skills along with the ability to type on a computer keyboard with ease and speed.</li><li>
Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and Power Point.</li><li>
Strong analytical and problem-solving skills to judge appropriateness of member services and treatments on a case-by-case basis.</li><li>
Knowledge of clinical standards of care and disease process and national, evidence based clinical guidelines and hospital operations.</li><li>
Knowledge of available community resources and programs.</li><li>
Basic understanding of the strategic and financial goals of a health care system, payer organization, health plan and/or health insurance operations (e.g. networks, eligibility, benefits).</li><li>
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.</li></ul> 
Additional Skills and Abilities:<ul><li>
The incumbent must have the ability to adapt to change while positively encouraging and motivating team members.</li><li>
The incumbent will have an onsite hospital-based assignment and must be able to travel onsite to their hospital-based assignment up to 5 days per week, at management's sole discretion. The incumbent is required to have the vaccinations listed below and be appropriately screened (and cleared) for the items listed below. If the incumbent does not have the vaccinations or have been screened (and cleared), they must do so upon acceptance of offer: 
<ul><li>TB screening (and repeat annually)</li><li>MMR-V Immunity</li><li>Influenza Vaccine (Seasonal)</li><li>COVID-19</li></ul></li><li>
The incumbent is required to complete the following training as assigned by Management, including, but not limited to: 
<ul><li>Infection control basics</li><li>TB Awareness</li><li>Bloodborne Pathogens (and repeat annually)</li></ul></li></ul>
** Onsite Hospital Assignments are subject to change based on evolving business needs. 
 
Salary Range: $72,216 - $143,429 
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
Inpatient DRG Telephonic
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
#LI-SS1</div>

Onsite Clinical Navigator (Hybrid)

<div>Resp &amp; Qualifications
PURPOSE:
 
This position supports the Post Acute clinical teams and their work coordinating care for CareFirst members by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination and/or quality of care, enabling clinical staff to perform at the top of their license. 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 a CareFirst location periodically for meetings, training and/or other business-related activities.
 
 
ESSENTIAL FUNCTIONS:<ul><li>
Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity.</li><li>
Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services and transitions to appropriate clinical resources/programs as required.</li><li>
Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.</li><li>
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care processes and/or tracking of Peer-to-Peer reviews.</li></ul>
QUALIFICATIONS: 
 
Education Level: High School Diploma or GED. 
 
Experience: 3 years experience in a health care or health insurance setting. 
 
Preferred Qualifications:<ul><li>
Previous experience in a health care/managed care setting or previous customer facing experience, especially in a medical management related department.
</li></ul>Knowledge, Skills and Abilities (KSAs)<ul><li>
Ability to effectively participate in a multi-disciplinary team including internal and external participants.</li><li>
Excellent communication, organizational and customer service skills.</li><li>
Knowledge of basic medical terminology and concepts used in care management.</li><li>
Knowledge of standardized processes and procedures for evaluating medical support operations business practices.</li><li>
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy.
</li><li>Ability to pay attention to the minute details of a project or task.</li><li>
Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point.</li>
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. 
<li>
</li></ul>Salary Range: $38,520 - $70,620 
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
Short Term Transitional Care
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
#LI-SS1</div>

Medical Management Coordinator I (Remote)

<div>Resp &amp; Qualifications
PURPOSE:
The data scientist associate with be a foundational contributor to our Artificial Intelligence (AI) and machine learning initiatives. Identifies and solves business problems using AI techniques to create actionable insight and drive business value. This role will build and maintain AI-powered solutions as part of a collaborative data-science team.
As a Data Scientist Associate, you will:<ul><li>
Join a collaborative team of AI and machine learning researchers with an extensive track record in both academia and industry</li><li>
Bring a combination of mathematical rigor and innovative designs to create solutions that extract relevant insights to effectively and efficiently improve health outcomes and operational practices</li><li>
Create thoughtful solutions that engage and empower the organization to make informed decisions</li><li>
Develop statistical/AI applications that can be reproduced and deployed on enterprise platforms</li><li>
Learn, develop, and apply new techniques in the intersection of AI, optimization, and machine learning</li><li>
Build tools and support structures needed to analyze data, perform elements of data cleaning, feature selection and feature engineering and organize experiments in conjunction with best practices</li><li>
Assist with the evaluation of data analytic techniques and solutions
</li><li>Collaborate with senior data scientists and associated departments to understand company needs and devise possible solutions leveraging the power of AI/Machine Learning</li><li>
Explain the results and implications of AI solutions and document the processes used in solution development</li></ul>
Some examples of the problems you might tackle in your new role:<ul><li>
How can we implement an AI solution to enhance productivity of internal teams or improve the experience of members and/or providers?</li><li>
How do we leverage our data that allows us to understand the unique needs of our members to support seamless care delivery that engages members, supports our providers and improves health outcomes?</li></ul>
ESSENTIAL FUNCTIONS:
Data Analysis and Exploration:<ul><li>
Data quality assessment and profiling</li><li>
Statistical analysis and hypothesis testing</li><li>
Feature discovery and relationship analysis</li></ul>
Model/Solution Development and Implementation:<ul><li>
Building and training machine learning models</li><li>
Algorithm selection and tuning</li><li>
Model evaluation and performance evaluation</li><li>
Feature engineering</li><li>
Prototype development proof-of-concepts</li></ul>
Data processing and pipeline development:<ul><li>
Data cleaning, transformation, and preprocessing</li><li>
ETL pipeline and maintenance</li><li>
Data source integration</li><li>
Database querying and extraction</li></ul>
Explores data patterns using existing data science tools:<ul><li>
Utilize the current tools to explore patterns within data and optimize solutions</li><li>
Identify opportunities for efficiency based on interaction between data and AI solutions</li></ul>
Translates business priorities to data science deliverables:<ul><li>
Work collaboratively to ensure business goals are met with data science solutions</li><li>
Assistance senior personnel with documenting and clarifying business needs</li></ul>
QUALIFICATIONS: 
 
Education Level: Bachelor's Degree in Statistics, Mathematics, Computer Science 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.
Licenses/Certifications Upon Hire Preferred:<ul><li>
Certified Data Professional
</li></ul>Preferred Qualifications:
<ul><li>Strong skills in programing and development with expertise in applicable programming languages (Python, R, Spark) and open-source machine learning and analytics packages</li><li>
Knowledge of large data sets and distributed computing (Hive/Hadoop)</li><li>
Proficiency with version control and collaborative development practices</li><li>
Experience with natural language processing and semantic search/similarity techniques</li><li>
Understanding of Large Language Model (LLM) usage in AI solutions and optimization techniques</li><li>
Fundamental knowledge of Agentic AI solutions and components (langchain, langgraph, crewAI)</li><li>
Basic understanding of MLOps such as model deployment modeling and lifecycle management</li><li>
Intermediate to advanced skills in SQL for data extraction and manipulation</li><li>
Familiarity with cloud platforms (AWS, Azure, Google Cloud)</li><li>
Experience building, training, and evaluating supervised and unsupervised models</li><li>
Understanding of feature selection, creation, and transformation techniques</li><li>
Skills in data cleaning, normalization, and preprocessing</li></ul> 
Knowledge, Skills and Abilities (KSAs)<ul><li>
Ability to work with minimal guidance.</li><li>
Ability to communicate effectively and document objectives and procedures.</li><li>
Fundamental knowledge in model evaluation, tuning and performance, operationalization, and scalability of scientific techniques.</li><li>
Understands fundamentals of software engineering principles and practices.</li><li>
Foundation in statistical modeling applications.</li>
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. 
<li>
</li></ul>Salary Range: $67,824 - $134,706
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
AI and Data Science Operations
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
#LI-LD1</div>

Data Scientist Associate (Hybrid)

Join CareFirst BlueCross BlueShield and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

CareFirst BlueCross BlueShield

ABOUT_COMPANY

Procurement Sourcing Manager (Hybrid)

Onsite Clinical Navigator (Hybrid)

Medical Management Coordinator I (Remote)

Data Scientist Associate (Hybrid)