QNXT Configuration Manager -- Remote USC/

We will consider a Senior Configuration Resource with 5+ years of hands-on QNXT 5.9 or higher configuration experience. They must have some Medi-Cal experience

Role: QNXT Manager, Configuration
Client- Health Plan of San Joaquin
Location: Remote- Must reside in California
Duration - 6 months CTH

Summary
Under general supervision, the Configuration Manager is responsible for developing and implementing department business plans and overseeing resources and department operations in a manner that ensures timely and accurate configuration of benefit plans and provider data in HPSJ's health information system in a manner that meets established turnaround, quality, and production goals, and regulatory standards. Work is varied and complex, requiring a moderate degree of discretion and independent judgment. The Manager of Configuration will lead a team of multi-disciplinary resources responsible for configuring and managing the QNXT core claims processing system, JIVA, the medical management platform, and additional ancillary core systems for the company. The Manager of Configuration must be capable of drawing sound conclusions; interpreting and following detailed and precise written and oral instructions; preparing clear, complete, and concise reports for review; supervising, evaluating, and training assigned staff; and having the ability to work well and effectively communicate with people of various professional, vocational and educational backgrounds.

Supervises

• Configuration Analysts, Provider Data Specialists (PDM)

Essential Functions

• Provide management and related abilities to support corporate goals and objectives.

• Provide leadership and management over the centralized Enterprise System Configuration team for QNXT, NetworX, CES, Optum, and JIVA employed by the Company. This includes reviewing any technical strategies, designs, and implementations, various initiatives, and ensuring adherence to the short-and longer-term technical roadmap.

• Build, manage, and energize team members with a proven 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 through business and financial plans and the ability to implement standard practices in business administration, management, human resources, and GAAP.

• Establishes and maintains cooperative working relationships with internal and external customers to solve operational technology issues related to system configuration, technical analytics, or help desk.

• Ensure proper management of the team's fiscal activities; develop a budget; manage contracts; establish and maintain procedures and systems for accurate and timely reporting on fiscal activities.

• Engages in team and department resource planning and work models, performs special projects and other duties as assigned.

• Manage documentation and test services over assigned functional areas to ensure successful change management including but not limited to a new system or application implementations, upgrades, or decommissioning.

• Manage a centralized core system configuration team that creates, modifies, and updates core system configuration changes to support operational business decisions.
• Create and establish data-driven analytics oversight of the organization's core system configuration and activities to ensure accurate and effective system operation.

• Establish, assist, or monitor configuration and business audits of the core system to ensure proper configuration, operational processing, security, or related business and technical needs.

• Ensure that core system configuration is recorded for historical purposes, integrated with company change management, and executed according to business design and requirements.
• Effectively communicate configuration questions, discrepancies, or issues to Management for immediate resolution.

• Create and establish collaborative, interactive work and projects supporting business and technical configuration efforts.

• Develop tools and programs to support daily configuration management activities and ensure that core system operations are implemented correctly and effectively.
• Create, implement, or support all core system configuration management policies and procedures.
• Responsible for training staff on core system configuration management to include but not limited to policies, procedures, operations, and oversight.

• Create and maintain a centralized configuration triage process, including initial intake, level one and two support, centralized management of third-party core system support tickets, and third-party defect and roadmap management.

• Manage and perform audits in the following areas: fee schedule updates, service code updates, category of aid, benefits management, service group management, and system synchronization for such areas.

• Provide technical analytics over process improvement for core systems, including enhancements to auto adjudication, automatic processing, reduction in manual processing, and adoption of new core system functionality.
• Coordinate with department and business leaders to analyze and elicit process improvement opportunities through software automation while assisting business disciplines in maturing through standard operational practices.

• Interpret policy and procedure guidelines and analyze information to adapt or modify operational and technology processes in response to changing markets, regulations, or business operations.

• Manage and engage in analytical situations, identify or evaluate alternatives, and define or implement technical or manual solutions within standards to meet the needs of the organization's operations.

• Analyzes proposed product or process design changes to determine the effect on the overall system, business impact, or human resources; and coordinates recording of modifications for change management control.
• Leverage database technologies to create data analytics and reporting to gather, review, and prepare statistical data to recommend operational changes using technology. For example, compiling charts, tables, or graphs to demonstrate Return on Investment (ROI) or efficiency gains.

Required

• At least eight years of progressively responsible Health Plan or Payer experience; and
• Recent 5+ years of QNXT configuration experience
• Medi-Cal claims experience
• Managed care experience
• At least eight years of health plan experience
• At least five years of supervisory experience
• Equivalent combination of education and experience.

Preferred

• Bachelor's Degree.

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