Care Manager, RN

Advance Sourcing Concepts Delaware City, DE
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We are seeking a Care Manager to become a part of our team! You will coordinate medical and health services in hospitals, clinics or similar organizations.

This is a contract position. This position is a contract with an OPTION to hire. The contract is scheduled to end January 2021.

JOB SUMMARY
This job supports one or more analytical aspects of the application product life cycle, including capability enablement with cross-team dependencies within a product scope. Uses significant independent judgement and discretion to collaborate with customers on the most complex issues in order to understand capability needs, gather project specifications, create business cases and cost sheet analysis, translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test plans, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Identifies, documents, and resolves risks, defects and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Business Systems Analysts, as well as others outside of immediate team. Leads project teams or actively participates as a SME on the most complex projects (cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as face to the customer; primary customer contact; may negotiate project requirements versus resources with customer. Resolves the most complex issues (may involve multiple systems) and/or develops alternative solutions with understanding of potential regulatory risk exposure and customer service & financial impacts, ensuring that resolution addresses all potential impacts. Act as a SME on how the most complex new enhancement/applications are developed using an expert level of understanding of end-to-end processes and potential integration issues. Requires expert level of understanding the end systems impact of changes across enterprise-wide systems (including regulatory risk exposure, customer service & financial impacts).

Responsibilities:

• Lead in working with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions for the clinical platform. Create and maintain clinical configuration deliverables such as business vision, requirements, testing plan, testing schedule, testing scenarios, testing outcomes, user task analysis, usability testing, personalization to different clients, and user interface design for clinical operations such as Appeals & Grievances, Member Services, Care Management, Population Health Management, Utilization Management, etc.
• Participate in the full software development life cycle by actively leading or acting as lead in given area of expertise in various roles, including, but not limited to, Business Technical Analyst, User Interface designer, Capability Manager, or Tester, based upon experience and need.
• Provide required business and/or subject matter expertise on most complex clinical issues for both project and production related activities, including new strategic programs or initiatives impacting configuration related activities.
• Configure, test, implement and maintain Clinical operation configuration rules to support changes in contracts, legislation, and payment policies and procedures
• Participate and lead reviews, impact assessments, testing and modifications for application updates, upgrades, and installations
• Ensure compliance to required standards and all necessary approvals have been obtained throughout the project lifecycle.
• Interface with the business areas, customers, partners, vendors, technical staff and project teams to drive value, return on investments and innovative solutions. This includes providing alternative solutions, including vendor solution acquisitions, with maximum benefits while reducing cost (e.g. cost benefit analysis, pros/cons of solutions).
• Lead in supporting various aspects of requirements testing (e.g. testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts.
• Communicate in an exemplary manner with team members, customers, partners and management, including assisting with or conducting requirement walkthroughs, reporting project status, enabling vendor solutions and providing accurate and concise documentation.
• Lead work effort for client focused documentation which is used during end user training and application adoption.
• Work with the training team on training content and structure. Conduct training when needed
• Act as a SME in Clinical configuration rules guiding the team on configuration tasks
• Provide thought leadership and strategic direction related to clinical operations configuration solutions and the Medicaid business.
• Understand and maintain configuration, contracts, products and policies
• Other duties as assigned.

Qualifications:

  • Bachelor's Degree in Business Administration/Management or Information Systems
  • 2+ years of GuidingCare experience
  • 2+ years of HealthEdge- HealthRules Payor experience
  • Previous experience in healthcare or other medical fields
  • Experience in a managerial role
  • Strong leadership qualities
  • Strong organizational skills
  • Excellent written and verbal communications skills
Advance Sourcing Concepts is an EEO employer - M/F/Vets/Disabled
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Advance Sourcing Concepts endeavors to make https://ascpeople.easyapply.co/job/care-manager-rn-1 accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact Judith Bernhard/Owner at 412-415-5080 or jbernhard@ascpeople.com