Senior Clinical Platform Operations Manager

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 120,000 - 223,000; Full time

Job summary

CareFirst BlueCross BlueShield seeks a senior operations leader to manage systems for Utilization Management, Case Management, and Appeals & Grievances. You will oversee a team of 8–12, drive SDLC from analysis to implementation, and partner with clinical stakeholders to optimize end-to-end processes in a high-availability healthcare environment.

The role emphasizes deep UM/CM/A&G domain knowledge, operation of core clinical applications, and budget and vendor accountability in a

Qualifications

• Bachelor’s degree in business administration or related field, or 4 additional years of relevant work experience.
• Minimum 5 years of business analysis experience and 1 year supervisory or leadership experience.

Responsibilities

• Lead a large operational team (8–12) and oversee defect triaging, release coordination, and production deployments.
• Translate clinical policies and business goals into daily operational execution for UM, CM, and A&G workflows.
• Manage SDLC activities including requirements, testing, SOPs, and implementation impact assessment.

Skills

People leadership

Project management

MS Office

Communication skills

UM/CM knowledge

Education

Bachelor's degree in Business Administration or related field

Tools

MS Office (Excel/PowerPoint/Word)

Job description

CareFirst BlueCross BlueShield seeks a senior operations leader to manage systems for Utilization Management, Case Management, and Appeals & Grievances. You will oversee a team of 8–12, drive SDLC from analysis to implementation, and partner with clinical stakeholders to optimize end-to-end processes in a high-availability healthcare environment.

The role emphasizes deep UM/CM/A&G domain knowledge, operation of core clinical applications, and budget and vendor accountability in a