IN4772-1
QA Manager with healthcare/insurance, quality audit, business analysis, project management, rules engine, medicaid, mita/mect, BizAgi and government experience
Location: Columbia SC
Qty: 1
Duration: 12 Months
DAILY DUTIES / RESPONSIBILITIES:
The Quality Manager is responsible for a PMI-oriented approach and methodology to ensuring DDI (Design, Development, and Implementation) process conformance, as well as assisting in monitoring and controlling the quality of project deliverables. The majority of the system development work will be performed by Clemson University.
Duties include:
• Understanding of solution requirements, monitoring development execution, and performing validation of deliverables against original requirements as expressed in a requirements traceability matrix.
• Assist the Project Management Organization in the design and implementation of templates relating to quality management processes to be used as organizational process assets throughout SC DHHS projects.
• Coordinating with the project’s Independent Validation and Verification entity regarding Quality Audits, requirements validation, and total quality management (Kaizen process development).
• Assist project director and project manager in the development of technical metrics for compliance with industry best practices and standards as defined by CMS and the ‘MITA-Mature’ Medicaid Information Systems suite of standards.
• Documenting and analyzing agency business processes and recommending improvements.
• Documenting and analyzing data requirements and relationships.
• Participating in the requirements management processes, including change control, version control, tracking and status reporting, and traceability.
• Providing requirements interpretation and guidance to test teams.
• Proactively identifying risks, issues, and action items leading to possible solutions; risk resolution techniques highly desired, including mitigation, transference, avoidance, and where required, acceptance.
• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
• Participating in standup of business operations supporting the Eligibility and Enrollment Member Management Project.
• Consolidating defect tracking and resolution efforts of the User Acceptance Team lead and respective staff, developing testing activity protocols, and developing techniques and standards for use in defect tracking and resolution.
• Cultivating a specialized team of field-based eligibility and enrollment staff assigned to testing activities, and packaging their results for resolution by software development teams in an agile software development lifecycle.
• Planning for, conducting, and reporting on testing and other quality assurance activities.
• Other duties as assigned.
Subject matter areas include member related eligibility determination, enrollment and disenrollment, eligibility inquiry, capitation premium payment, health insurance premium payment, Medicare premium payment, premium invoice, program policy, and state plan. Familiarity with the Affordable Care Act and impacts on Medicaid eligibility and member related processes is also beneficial.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Quality management experience on major IT healthcare systems development
• Strong background and at least six years in healthcare insurance operations (payer or provider side; government or commercial side). Experience in multiple business areas is a plus. Note: IT operations are not the same as business operations.
• At least three years’ experience in healthcare insurance IT software/systems implementations performing duties described in the “Daily Duties/Responsibilities” section above.
• Ability to properly document quality audit and monitoring and controlling activities.
• Ability to interpret business process and business data models.
• Experience in creating solution metrics within an IT healthcare solution environment.
• Experience using modern commercial rules engines and their respective orchestration layers.
• Superb written and oral communication skills, including the ability to give presentations to executive management. Strong proficiency in English is required.
• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and organizations on a continuous basis.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Medicaid eligibility system/business operations experience
• Knowledge/experience with the BizAgi BPM tools a plus
• Understanding of the Medicaid Information Technology Architecture (MITA)
• Understanding of the Medicaid Enterprise Certification Toolkit (MECT)
• Experience in an outsourced IT development project
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