Solutions SME

Job Description

At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member's health journey. We do this through state-of-the-art technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance.

The Solutions Team Subject Matter Expert (SME) drives the success of customer implementation and production support to ensure expectations are met and ensures continued customer satisfaction. The Solutions SME serves as the Solutions group's interface to customer operations which includes implementation, production support, development, configuration, quality assurance, product documentation, compliance, and other internal departments. The Solutions SME provides product direction throughout the customer lifecycle to ensure a consistent customer experience and to maintain the integrity of the broader MHK platform. The ideal candidate has the passion and desire to create highly satisfied customers, improve the product line, advance their own knowledge, and help remove impediments so the team can consistently move forward.

Responsibilities:

• Support client implementations of Utilization Management/Care Management, Complaints, Appeals & Grievance Management and Pharmacy Management software as a subject matter expert (SME) for the product definition, market trends and dynamics, development process and current industry events/impacts.
• Define Utilization Management, Care Management, Appeals/Grievance Management and Pharmacy Management product content, workflows and SLA's to meet client and regulatory / accreditation requirements.
• Work closely with internal release management, development, IT/Operations, compliance and other departments for timely implementation of new platform feature enhancements, continued product support and product innovation.
• Understand client business processes to successfully implement MHK Module of Excellence standard solutions.
• Document and maintain use case requirements to test accurate system functionality testing.
• Conduct end to end Utilization and Care Management, Appeals & Grievances Management and Pharmacy Management module testing to ensure accurate functionality prior to releasing to internal models and/or new revision releases.
• Identify problems within the Utilization and Care Management, Appeals & Grievance Management and Pharmacy Management products and communicate them through established change management process.
• Provide Solutions approval of Utilization and Care Management, Appeals & Grievances Management and Pharmacy Management as required by the release management process.
• Active participation in production support, implementations, and projects for MHK clients
• Able to adapt to competing demands, take on new responsibilities, and adjust plans to meet changing priorities.
• Maintain positive, constructive approach to problem solving internally and during customer interactions with focus on timely and accurate issue resolution.
• Perform other duties as assigned by Manager.

Education/Certification:

• Bachelor's Degree in Computer Science, Healthcare, Marketing or related fields, preferred.

Knowledge/Skills/Abilities:

• Three to five (3-5) years of professional experience within a health plan and managed care is preferred.
• Five (5) years Utilization Management/Care Management, Complaints, Appeals, Grievances Management and/or Pharmacy Management experience strongly preferred.
• Previous experience translating business requirements into system configuration preferred.
• Previous "Scrum" based product development experience in SaaS environment preferred, including hands-on active participation in production support, implementations, and projects.
• Previous experience performing detailed market, competitive, customer needs and software product feature analysis preferred.
• Previous experience defining, building, and executing test cases preferred.
• Experience working with/knowledge of CMS, NCQA and/or URAC or other Health Plan accreditation and regulatory compliance preferred.
• Experience presenting and communicating with all levels of organizations.
• Excellent written, verbal communication and interpersonal skills
• Proficient with Word, Power Point, Excel, Visio and Document Management
• Previous Clinical experience (RN, LPN) is a big PLUS

Additional Requirements:

• Some occasional travel to clients may be necessary (as needed.)
• Ability to sit for extended periods of time.

COMMITMENT TO DIVERSITY & INCLUSION:

We are committed to cultivating and preserving a culture of inclusion and connectedness through collaboration. We grow and learn better together with a diverse team of employees. We welcome the unique contributions and the different perspectives of a diverse team. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

For more information, please visit Know Your Rights, Pay Transparency, and MHK EEO/AA Statement

Benefits Snapshot:

• Medical, vision, and dental plans for full time employees
• 401(k) offered with a generous match
• Benefits begin on first day of the month following employment
• Exercise/Health Club reimbursement opportunity
• Monthly dependent care reimbursement opportunity
• Short Term and Long Term disability
• Basic Term Life and AD&D Insurance

Paid Time Off

• 15 days Paid Time Off
• 13 Company Paid Holidays
• 3 Personal Days
• 2 Community Service days