GuidingCare Consultant

Sr No

Position

Detailed JD

1

Config Analyst - Application Support

Job Summary:

The GuidingCare Configuration Analyst is responsible for the setup, customization, and maintenance of the GuidingCare care management platform. This role ensures that the application meets business and clinical needs by configuring workflows, rules, forms, assessments, and integrations. The analyst collaborates with stakeholders across business, clinical, and technical teams to support system enhancements and ensure efficient care management processes.

Key Responsibilities:

Configure core components of the GuidingCare platform including assessments, care plans, workflows, forms, task rules, and alerts.

Customize user interface elements and role-based access to support user-specific views and permissions.

Translate business and clinical requirements into functional system configurations.

Collaborate with care management teams to test and validate new configurations or system enhancements.

Maintain and update configuration documentation and versioning logs.

Participate in system upgrades, releases, and patches, ensuring configurations remain compatible and functional.

Analyze and resolve configuration issues or data flow gaps with internal IT teams and vendors.

Support user acceptance testing (UAT) and post-deployment validation activities.

Ensure system compliance with NCQA, HEDIS, and CMS standards where applicable.

Collaborate with GuidingCare/HealthEdge technical support on escalated issues and configuration best practices.

Qualifications:

Experience:5 8 years of experience working with care management systems, ideally HealthEdge GuidingCare.

Strong understanding of healthcare workflows (e.g., utilization management, case management).

Experience in configuring complex software systems in a healthcare environment.

Skills:

Familiarity with GuidingCare modules (Care Coordination, Utilization Management, LTSS, etc.).

Strong analytical, documentation, and problem-solving skills.

Excellent communication and cross-functional collaboration abilities.

Basic knowledge of relational databases and tools like Excel or SQL for data validation.

Ability to manage multiple priorities in a fast-paced environment.

Preferred Certifications:

HealthEdge GuidingCare Certification (if available)

HIPAA compliance training

2

Config Analyst - Letters

Guiding Care Configuration Letter Resources

Job Summary:

We are seeking an experienced and detail-oriented professional to join our team as a GuidingCare Configuration Letter Specialist. The resource will be primarily responsible for designing, configuring, and testing the Letter Templates and Correspondence module in the HealthEdge GuidingCare platform, ensuring compliance with healthcare regulatory and operational requirements. The candidate will collaborate with business analysts, developers, quality assurance, and business stakeholders to deliver accurate, timely, and compliant member and provider communications.

Key Responsibilities:

• Analyze business and regulatory requirements to design and configure custom letters, forms, and notifications within the GuidingCare platform.
• Create and manage dynamic templates using GuidingCare s Letter Management module, including use of tokens, placeholders, business rules, and conditional logic.
• Integrate letter generation with care management workflows and ensure automated triggers based on events such as assessments, care plans, service authorizations, or other configurable parameters.
• Collaborate with cross-functional teams to gather letter content requirements, approvals, and translation needs.
• Coordinate UAT and QA activities for all correspondence configurations to ensure accuracy, formatting, and compliance.
• Maintain letter audit trails and documentation for regulatory and operational review.
• Work with external print vendors or mail services for delivery mechanisms where applicable.
• Develop and maintain training and user guides for business users and operational staff related to letter configurations.
• Monitor and troubleshoot letter delivery issues, ensuring SLAs and compliance are maintained.

Required Skills and Qualifications:

• 5 8 years of experience in Healthcare IT, with 3+ years specifically in HealthEdge GuidingCare configuration, including hands-on experience in the Letter Management module.
• Strong understanding of care management workflows and healthcare correspondence compliance requirements (e.g., CMS, NCQA, state Medicaid guidelines).
• Experience working with HTML/CSS or XML for letter formatting and customization.
• Familiarity with tokenization, dynamic data binding, and conditional logic in templated correspondence systems.
• Excellent written and verbal communication skills to liaise with business stakeholders and document configuration changes clearly.
• Ability to manage multiple letter templates and configurations simultaneously with high attention to detail.
• Strong troubleshooting, testing, and analytical skills.

Preferred Qualifications:

• Prior experience with HealthEdge GuidingCare.
• Exposure to integrating GuidingCare letters with external print vendors or digital delivery systems.
• Knowledge of HIPAA and healthcare data privacy/security best practices.
• Experience in agile project environments, using tools like JIRA, Confluence, etc.

3

Config Analyst FICO

Guiding Care FICO Configuration Analyst

Job Summary:

We are seeking a skilled GuidingCare FICO Configuration Analyst to support the implementation, configuration, and optimization of the GuidingCare platform with a specific focus on the FICO Rules Management and configuration components. The ideal candidate will have a strong understanding of healthcare workflows, experience with care management platforms, and in-depth knowledge of FICO rules and decision services within the GuidingCare ecosystem.

Key Responsibilities:

• Configure and maintain FICO rules within the GuidingCare platform based on business requirements. Translate clinical and operational workflows into rule logic and configuration parameters.
• Work with business analysts, clinicians, and technical teams to gather and validate rule requirements.
• Design and document business rules, decision tables, and strategies using FICO Decision Management tools.
• Perform unit testing and support UAT for rule changes and configurations.
• Collaborate with stakeholders to identify opportunities for rule optimization and automation.
• Troubleshoot and resolve issues related to rule execution and decision-making processes.
• Ensure configuration aligns with regulatory, compliance, and organizational standards.
• Maintain detailed documentation of configurations, change logs, and release notes.
• Support deployment of configuration updates to test and production environments.

Required Qualifications:

• 3+ years of experience with HealthEdge GuidingCare, including configuration and customization.
• Hands-on experience with FICO Blaze Advisor or FICO Decision Management Suite.
• Understanding of healthcare domain, especially care management and utilization management workflows.
• Strong analytical, problem-solving, and documentation skills.
• Experience with XML, JSON, and web services is a plus.
• Familiarity with Agile/Scrum development methodologies

Preferred Skills:

• Prior experience in Medicaid, Medicare, or duals programs.
• Exposure to other modules in GuidingCare (e.g., Assessments, Authorizations, Care Plans).
• Knowledge of HL7, FHIR, or EDI transactions is an advantage.
• Experience in integrating FICO decisioning with other enterprise systems.