Resp & Qualifications
CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.
In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company’s COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company’s core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.
At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.
We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees’ experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.
- Women make up around 70% of CareFirst’s employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
- We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
- Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.
As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company’s employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company’s continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal’s 2019 list of top corporate givers, respectively.
Expert clinical practitioner responsible for providing direct management and oversight of all behavioral health services to include all functions of behavioral health care management and the programs and services that support the behavioral health and substance use disorder patient care populations. Provides strategic leadership in design and implementation of a cogent behavioral health strategy to ensure strategic alignment with divisional and corporate goals, and with the needs of members, providers and accounts.
- Develops departmental policies and procedures for behavioral health services. Provides strategic direction, and develops and maintains quality-improvement programs to optimize patient care. Oversees care coordination activities related to behavioral health and substance use disorder.
- Collaborates with physicians/provider leaders to ensure service expectations are being met.
- Serves as a resource for the behavioral health management team and other departments.
- Establishes the workflow of care managers, social workers and discharge planners.
- Presents status of key performance indicators and make recommendations on continuous improvement opportunities to the executive leadership team.
- Maintains and develops relationships with key thought and business leaders in the health care delivery marketplace.
- Directs the strategic and the day-to-day activities of the Department, including coaching and guiding individuals and teams in order to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.
This position manages people.
Education Level: Master’s Degree in Mental Health; education can be in one or more of the following areas: Social Work, Psychology, Nursing or Counseling
LCSW- License Clinical Social Worker or
LMAFT – Lic-Marriage & Family Therapy or
LPC-Licensed Professional Counselor
- 8 years post masters clinical behavioral health/psychiatric experience.
- 3 years management experience.
- Doctoral degree in Psychiatric Nursing or Mental Health
Knowledge, Skills and Abilities (KSAs)
- Ability to communicate effectively verbally and in writing.
- Knowledge of health benefits industry, products, trends, consumer market, and competitive intelligence.
- Knowledge and proficiency in use of metrics and measures in managing programs and services.
- Strong organizational skills to manage multiple projects, issues and priorities.
- Extensive knowledge of managed care delivery guidelines and systems.
- Extensive knowledge of behavioral health diagnoses.
- Demonstrated application and knowledge of best behavioral health clinical practices.
- Demonstrated advanced knowledge and skills in the areas of clinical expertise, evidence-based practice, and providing the related consultation, education, mentoring.
- Requires ability to model excellence in advanced behavioral health clinical practice within a specialty population.
- Skilled at being persistent, modifying tactics based upon reading another person’s statements and body language.
- Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 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.
Department: DC Medicaid – Health Administration
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.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
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.
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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