Capital Blue Cross

Senior Utilization Management Data Analyst

Capital Blue Cross · Full Time · 17 hours ago

Capital Blue Cross

🌎 United States 💵 $72870 - $137K per year ⭐ 5-10 yrs exp 💼 Software Development

This role coordinates Utilization Management business needs and integrates them with internal application systems and the enterprise data warehouse. The analyst is responsible for developing data solutions, ensuring regulatory compliance, and serving as a subject matter expert for UM data integrity.

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Health Navigator - LPN

Capital Blue Cross · Full Time · a day ago

Capital Blue Cross

🌎 United States 💵 $24.79 - $46.7 per year ⭐ 2-5 yrs exp 💼 Healthcare

The Health Navigator coordinates services and addresses barriers to care by collaborating with members, families, and healthcare providers. They provide education, facilitate access to community resources, and monitor member needs to ensure effective healthcare navigation.

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Provider Audit Specialist

Capital Blue Cross · Full Time · 5 days ago

Capital Blue Cross

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

Conduct end-to-end audits of provider chargemasters 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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RN Care Manager

Capital Blue Cross · Full Time · 15 days 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 by assessing needs and implementing individualized plans of care. They serve as a liaison between patients, families, and providers to promote quality care and cost-effective health outcomes.

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RN Care Manager - Oncology

Capital Blue Cross · Full Time · 18 days 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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Network Reimbursement Analyst II

Capital Blue Cross · Full Time · 22 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 provide analytical support, research reimbursement issues, and coordinate the implementation of professional and facility provider rate changes.

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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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Provider Contract Manager

Capital Blue Cross · Full Time · 3 months ago

Capital Blue Cross

🌎 United States 💵 $98880 - $186K per year ⭐ 10+ yrs exp 💼 Legal

This role leads strategic provider partnerships, including hospitals and physician groups, to negotiate contracts, execute negotiation strategies, and implement innovative reimbursement models like value-based programs. The individual ensures contracts meet regulatory and financial requirements while collaborating across internal teams to support performance programs.

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