[Hiring] QNXT Configuration Manager @DMS Vision

Role Description

The Configuration Manager will be responsible for configuration of benefit plans and provider data in the Plan's health information systems. They will lead a team of multi-disciplinary resources that are responsible for the configuration and management of the QNXT core claims processing system, JIVA the medical management platform, and additional core systems as needed.

• Provide management and related abilities in support of the corporate goals and objectives.
• Provide leadership and management over the centralized Enterprise System Configuration team for QNXT, NetworX, CES, Optum, and JIVA.
• Build, manage, and energize team members with a focus on delivering business results with excellent customer service.
• Create technical policies and procedures, and work as, or with, a Project Manager on project cost, resource estimation, tasking, and timely project completion.
• Provide leadership for IT in making effective and efficient use of financial resources.
• Establish and maintain cooperative working relationships with internal and external customers.
• Ensure proper management of the team's fiscal activities; develops budget; manages contracts.
• Engage in team and department resource planning and work models.
• Manage documentation and test services over assigned functional areas.
• Manage a centralized core system configuration team that creates, modifies, and updates core system configuration changes.
• Create and establish data driven analytics oversight of the organization's core system configuration.
• Establish, assist, or monitor configuration and business audits of the core system.
• Ensure that core system configuration is recorded for historical purposes.
• Effectively communicate configuration questions, discrepancies, or issues to Management.
• Create and establish collaborative and interactive work efforts and projects.
• Develop tools and programs to support daily configuration management activities.
• Create, implement, or support all core system configuration management policies and procedures.
• Be responsible for training staff on core system configuration management.
• Create and maintain a centralized configuration triage process.
• Manage and perform audits in various areas including fee schedule updates and service code updates.
• Provide technical analytics over process improvement for core systems.
• Analyze and elicit process improvement opportunities through software automation.
• Interpret policy and procedure guidelines and analyze factual information.
• Manage and engage in analytical situations, identify or evaluate alternatives.
• Analyze proposed changes of product or process design to determine effect on overall system.
• Leverage database technologies to create data analytics and reporting.

Qualifications

• Bachelor's Degree in Computer Science Information Technology, or related discipline.
• 8 years of Health Plan or Payer experience.
• 5 years of supervisory experience.
• 5 years Medi-Cal (California Medicaid) claims experience.
• Prior managed care experience.
• Be willing to work Pacific Standard Time (PST) hours.
• In-depth knowledge of regulations and procedures governing Medi-Cal and other state sponsored programs.
• Strong knowledge of database concepts and terminology.
• Strong knowledge of health information systems related to benefit plan and provider setup.
• Strong knowledge of contract components and language.
• Strong knowledge in at least four health plan functional areas, such as Authorizations, Claims, Providers, and Membership.
• Knowledgeable of the features, functions and configuration of all QNXT modules or other healthcare claims processing system.

Company Description