Company :Highmark Inc.
Job Description :
Plans, and manages the system configuration implementation of the strategic business and functional infrastructure (existing and future) of the underlying systems that support the respective business platforms for the Medicaid Business Unit market served by Highmark. Oversees configuration change management activities related to benefits, prior auth requirements and medical policy, code sets, business rules, screen design and functionality, templates, workflows, user task analysis, personalization to different plans, and user interface design for clinical operations such as Appeals & Grievances, LTSS, Care Management, Utilization Management, and Population Health Management. Directs the requirement development, testing and refinement of the underlying systems, defines strategic and tactical approaches to improve business systems to support the underlying workflow of these systems, and is a contributor to the divisional planning process and senior management team. Responsible for managing the identification of enhancements and expanded capabilities of the Clinical Platform system including design, developing, modifying, adapting and implementing short- and long-term solutions to information technology (IT) and business process/technology solutions through new and existing applications, systems architecture, network systems and applications infrastructure. Includes hands-on configuration in production and test environments, incident tracking and resolution, release management, and project management. Reviews system requirements and business processes, ensures quality outcomes, participates in code walkthroughs and tests, debugs to implement software solutions. Develops policies & procedures in support of standardized and accurate configuration and maintenance. Remains informed of clinical practices and federal and state healthcare Medicaid regulations
- Acts as business platform(s) owner and directs the daily operations of the underlying systems, supporting and contributing to strategic and tactical initiatives to improve these operations and systems, defines, enhances and/or supports the underlying workflow of these systems. Responsible for directing the identification of enhancements and expanded capabilities of these major enterprise systems through direct facilitation with the business and user community.
- Partners closely with the PMO staff, stakeholders, IT and others who support and/or use the underlying systems and processes and directs the infrastructure support for the respective business platform and directs support and integration of data and knowledge used to service group customers, consumer’s and/or providers.
- Resolve high impact platform, defect or business technical issues. Directly facilitates active and ongoing communication with the user community.
- Oversees the design, development, modification, adaptation and implementation of short- and long-term solutions to information technology (IT) and business solutions through new and existing applications, systems architecture, network systems and applications infrastructure
- Identify, implement, and adhere to multi-state and federal government regulations, corporate policy mandates, corrective action plans, compliance requirements and process improvement initiatives impacting systems, operating platform and associated process and workflows.
- Work with director and stakeholders to ensure development and implementation of department and corporate strategic and tactical business platform initiatives. Contributes to the planning efforts to support the strategic planning process as it relates to their assigned applications and impacts to those systems or processes.
- This role will at times be accountable to directly deliver projects or programs and/or actively participate in transformational initiatives. These could include managing complex matrix relationships across business units or even business entities within Highmark or its strategic business partners. When this is the case, there may be less direct reporting relationships and more matrix relationships demanding extensive relationship management skills. These types of assignments would be of the small to medium sized projects / programs and/or mid-level complexity or scope.
- Ensure continuous platform improvement by responding to feedback and championing process improvement initiatives by empowering their team to deliver quality services/products to internal and external customers. Increase knowledge sharing and new hire on-boarding by ensuring properly maintained documentation of the platform’s features, functions and associated processes. Develop and implement short-term and long-term departmental goals.
- Display the ability to accept direction and provide leadership to develop/maintain a high-performance team. Coach, mentor, manage and develop employees by establishing clear goals, expectations, and strategies for employee performance. Manage the growth and career of employees to enable them to meet the current and future needs of the transforming organization. Develop and administer performance reviews with measurable goals. Assess employee skills and oversee personal development plans as it relates to career development. Ensure employees complete individual development plans (IDP) annually. Ensure timely completion of staff training. Promote and participate in team building activities.
- Manage teams that span geographic areas or functional areas.
- Promote diversity and inclusion.
- Other duties as assigned or requested.
- High School Diploma / GED
- Bachelor’s Degree
- 5 years program management (to include managing programs and leading the teams) or people-leader experience (Manager, Supervisor or Team Lead)
- 5 years of managing technology-related projects and experience working with operational computer systems
- 5 years utilizing various industry laws and regulations
- 5 years extensive insurance product knowledge
- 5 years experience in workforce development and resource management
- 5 years with business process improvement
- Experience with Altruista/Guiding Care
- Hands on configuration experience
- Experience working in a SaaS model
- Medicaid Knowledge
LICENSES or CERTIFICATIONS
- Leadership skills and ability to relate to all levels of management and staff as well as external customers.
- Experience evaluating technology for implementation in gaining improved services
- Experience in reengineering processes and procedures to achieve costs reductions
- Strong business writing and oral communication skills.
- Excellent team building and professional development skills.
- Advanced negotiation and influencing skills.
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:$92,300.00
Pay Range Maximum:$170,800.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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