Functional Architect - GuidingCare

Job TItle: Functional Architect - GuidingCare - 244891
Work Location: 100% Remote in the US
Position Type: Consulting - 6+ Months
Compensation Range: Negotiable, based on experience (W2 or 1099/LLC)

ABOUT OUR CLIENT / ABOUT THIS ROLE

Medix is currently seeking a Sr. Business Analyst / Functional Architect to help lead the implementation and configuration of HealthEdge (Altruista) Guiding Care with one of our Managed Care clients.

This is a highly specialized role - we are seeking an experienced resource who has significant experience working in a MCO /Health Plan, and who has prior experience building out functionality for Care Management / Utilization Management / Appeals / Grievances.

RESPONSIBILITIES

• Serving in Lead Business Analyst / Functional Architect capacity, reporting to a VP of Core Applications


• Providing a deep understanding and subject matter expertise on the HealthEdge GuidingCare platform, to help manage the custom business requests funneling down the pipeline


• Leading requirements analysis and translating business needs / requests to system configuration - spanning Care Management Utilization Management, Appeals and Grievances


• Providing the business rules design for custom configuration solutions, and partnering with / managing an external configuration vendor


• Conducting roadmap planning for end to end lifecycle management for system configurations


• Automating processes to speed up testing cycles and improve efficiency.


• Ensuring overall Core Systems integrity by prevent configuration changes from negatively impacting other parts of the Health Plan


• Leading with industry best-practices and subject matter expertise in the Health Plan and Managed Care space (Medicare, Medicaid, Child Health Plus)


• Collaborating across various departments, such as policy, markets, and product management, to enhance processes and resolve conflicts.

REQUIRED EXPERIENCE & QUALIFICATIONS

• Required Bachelor of 4-year College Degree


• Required 8+ Years of professional experience within a Health Plan / Managed Care organization


• 8+ years experienced as a Senior Business Analyst, Product Owner or Functional Architect


• Subject Matter Expertise with HealthEdge (Altruista) Guiding Care


• Experienced in configuring Care Management, Utilization Management, Appeals and Grievances

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.