Capital Blue Cross

Clinical Development and Education Consultant

Capital Blue Cross · Full Time · 20 minutes ago

Capital Blue Cross

🌎 United States 💵 $63350 - $119K per year ⭐ 5-10 yrs exp 💼 Healthcare

The consultant is responsible for planning and executing educational programs, onboarding, and professional development for clinical staff. They also partner with leadership to develop workflows and ensure compliance with regulatory and accreditation standards.

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Privacy and Compliance Specialist

Capital Blue Cross · Full Time · 20 hours ago

Capital Blue Cross

🌎 United States 💵 $55100 - $103K per year ⭐ 2-5 yrs exp 💼 Legal

The specialist develops and monitors privacy and compliance programs to ensure adherence to regulatory and organizational requirements. They handle privacy inquiries, investigate incidents, and coordinate compliance training and audit activities.

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FEP Corporate Performance Analyst

Capital Blue Cross · Full Time · a day ago

Capital Blue Cross

🌎 United States 💵 $47800 - $91070 per year ⭐ 5-10 yrs exp 💼 Others

Responsible for auditing Plan performance regarding membership, claims, and customer service activity in accordance with BCBSA guidelines. Provides analysis and reporting for Performance Guarantee accounts and assists with external client audit requests.

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Clinical Support Specialist

Capital Blue Cross · Full Time · 4 days ago

Capital Blue Cross

🌎 United States 💵 $18.5 - $34.9 per hour ⭐ 2-5 yrs exp 💼 Support

Provides administrative support to clinical teams by managing medical records, authorizations, and referral processes. Handles member and provider communications and monitors compliance reports to support medical management functions.

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Network Reimbursement Analyst II

Capital Blue Cross · Full Time · 5 days ago

Capital Blue Cross

🌎 United States 💵 $55100 - $103K per year ⭐ 2-5 yrs exp 💼 Others

The analyst develops and administers pricing for healthcare provider contracts and manages the configuration of pricing schedules. They research reimbursement issues and provide analytical support to the Network Provider Contracting and Analytics teams.

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Medical Director - Behavioral Health

Capital Blue Cross · Full Time · 6 days ago

Capital Blue Cross

🌎 United States 💵 $212K - $344K per year ⭐ 10+ yrs exp 💼 Healthcare

Provide physician leadership and clinical expertise to develop and implement Capital's behavioral health strategy and programs. Collaborate with internal departments and external providers to drive Triple Aim outcomes and improve access to integrated care.

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Network Contract Analyst

Capital Blue Cross · Full Time · 8 days ago

Capital Blue Cross

🌎 United States 💵 $63350 - $119K per year ⭐ 2-5 yrs exp 💼 Others

The Network Contract Analyst manages provider contract administration, including preparing settlements and ensuring accurate payment levels. They perform research and data analysis to support reimbursement strategies, contract negotiations, and regulatory compliance.

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Provider Audit Specialist

Capital Blue Cross · Full Time · 8 days ago

Capital Blue Cross

🌎 United States 💵 $55100 - $103K per year ⭐ 2-5 yrs exp 💼 Others

Conduct end-to-end audits of provider charge masters and claims to ensure billing accuracy and regulatory compliance. Analyze data to identify irregularities and collaborate with teams to recommend process improvements and financial recoveries.

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Enterprise Architect

Capital Blue Cross · Full Time · 20 days ago

Capital Blue Cross

🌎 United States 💵 $118K - $223K per year ⭐ 5-10 yrs exp 💼 Software Development

Leads architecture for a specific business domain and guides Agile PODs to deliver secure, scalable solutions. Drives application rationalization and adoption of reference patterns in Azure.

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RN Care Manager - Oncology

Capital Blue Cross · Full Time · a month ago

Capital Blue Cross

🌎 United States 💵 $28.25 - $53.24 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager coordinates services for high-risk members, focusing on education, self-management, and cost-effective health outcomes. They assess member needs, develop individualized care plans, and collaborate with providers and community agencies to optimize health status.

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HEDIS Performance Analytics Lead

Capital Blue Cross · Full Time · 2 months ago

Capital Blue Cross

🌎 United States 💵 $83800 - $157K per year ⭐ 10+ yrs exp 💼 Software Development

Lead the development of predictive models and analytical frameworks to identify HEDIS performance gaps and prioritize improvement initiatives. Translate complex data into actionable strategic recommendations for executive stakeholders to improve quality outcomes and ROI.

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