Industry: Managed Care & Health Insurance•
Less than 5 years
Posted 401 days ago
Care Management Operational Solutions (CMOS) brings together three teams who are responsible for the design, development, implementation and support for clinical systems and operational reporting for Health Care Management. CMOS bridges the gap between HCM business and Information Technology (IT) teams and ensures the clinical systems support the business objectives, quality standards and data/reporting needs.
Overall focus will be to ensure that Inbound, Outbound, and Transitional Utilization Management data feeds from Delegated Risk Entity Groups are implemented, executed, and maintained for Anthem’s GBD Utilization Management foundation.
Primary duties may include, but are not limited to:
* Being a member of Agile Kanban team to define, build, prioritize work within a continuous delivery pipeline.
* Provides the link between the technical and business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.
* Translate business needs into business requirements/user stories
* Determines specific business application software requirements to address complex and varied business needs.
* Consults with business partners (internal and external) concerning application and implementation of technology.
* Develops and maintains systems and data feeds vision, mission, and strategies to support the enterprise business plan.
* Creates and executes feature test cases and ensures feature testing effectively validates that the system meets the functional and non-functional requirements.
* Assists in the translation of the business requirements into implementation details and ensures design meets performance, usability, reliability and scalability requirements in addition to the functional requirements. Provides support during the integration and acceptance testing phases and implementation.
* Identifies impacted cross functional parties, business partners, and resources required.
* Acts as a resource to address questions/issues.
Position to be located in Norfolk, VA Office. Possibility of Work from home based upon candidate.
Monday – Friday core business hours (8:30 AM to 5:30 PM core business hours) EST scheduled preferred
Requires BA/BS in information systems or related field; 3 or more years systems analysis related experience; or any combination of education and experience, which would provide an equivalent background. Managed care experience preferred. Experience testing, documenting test results, define and develop use cases is required. Experience with JIRA, Utilization Management, Agile processes, 278 (X12) Transactions and ADT preferred. * Excellent organizational, time and project management skills. * Ability to handle complex information with accuracy and attention to detail. * Self-development skills to keep up-to-date with fast-changing trends and their role in a commercial environment. * Professional approach to time, costs and deadlines. * Good team working and interpersonal skills required to enable working closely with staff at all levels throughout an organization, including managers and IT specialists. * Ability to communicate technical information and ideas clearly and concisely to non-technical people.