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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.
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 projects.
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).
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.
Planning for, conducting, and reporting on testing and other quality assurance activities.
Support activities to gain approval for certification for the system from state and federal partners.
Help identify project schedules to ensure all dependencies from a testing and logistics perspective are accounted for.
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 its impacts on Medicaid eligibility and member-related processes is also beneficial.
REQUIRED SKILLS
3+ years of Quality management experience on major IT healthcare systems development
3+ years experience in healthcare insurance IT software/systems implementations, performing duties described in the Daily Duties/Responsibilities section above.
Experience using modern commercial rules engines and their respective orchestration layers.
PREFERRED SKILLS
Medicaid eligibility system/business operations experience
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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