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Test Lead - UM/CM

Eagan, MN, US • Posted 1 hour ago • Updated 1 hour ago

Contract W2

On-site

Depends on Experience

Fitment

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Job Details

Skills

Summary

Top 3 Must Have Skills:

Healthcare
UM/CM
Test strategy

................................................................................................................................

Test Lead – UM/CM
Contract through March 2028
Eagan, MN

Skills needed..

Utilization Management (UM)
Case Management (CM)
Medical Management
Healthcare background
Test Strategy
3-5 years of lead experience

Job Description:

MEDICAL MANAGEMENT PORTFOLIO ROLES DESCRIPTION

Responsible for defining and executing the testing strategy for UM , CM and Member Appeals implementations, including functional, integration, UAT, and end-to-end testing. This role ensures quality delivery through robust test planning, execution, and collaboration across business and technical teams.

Develop and maintain comprehensive test strategy and plans for workflows.
Lead System Integration Testing (SIT), UAT, end-to-end, and mock go-live cycles.
Design detailed test scenarios and scripts for clinical workflows in collaboration with clinical and business leads.
Manage test resources, including manual and automated testing efforts.
Partner with cross-functional teams (Appeals, Claims, Member Services, Provider Relations, Product & Benefits, Data & Analytics).
Execute test scripts, track results, and manage defect lifecycle.
Ensuring system allows the business to be in compliance with healthcare regulations (HIPAA, NCQA, CMS, Local and State regs)

Responsibilities during discovery
Test Strategy Development Based on Discovery
Testing does not start yet, but planning does.
Months 1–3
1. Test Strategy Development

Define:
- Testing approach (Unit, SIT, UAT, end to end)
- Traceability from requirements to test cases

2. Requirement Review for Testability

Validate that:
- Requirements are measurable
- Acceptance criteria are defined
- Regulatory timeframes are clearly documented
- Business Rules and Decision outcomes are clearly defined.
- Required data elements and input fields are identified.
- Integration points and System dependencies are clearly documented.

3. Test Scenario Planning

Draft high-level test scenarios:
- Standard auth
- Expedited auth
- Retro auth
- Partial approval/ denial
- Appeal conversion
- CM referral from UM

4. Environment Planning

Identify test data needs
Coordinate environment strategy with IT

Key Deliverables:

Master Test Strategy
Traceability Matrix (linked to BA requirements)
High-Level Test Scenario Library
UAT and Staffing Model Draft

Test Lead Responsibilities During Implementation

Own the overall testing strategy and ensure it aligns with the implementation scope, requirements, and timeline.
Review the existing test strategy and identify any gaps, outdated assumptions, or areas that need to be revised.
Develop and maintain the test plan, including scope, testing phases, timelines, resources, dependencies, and entry/exit criteria.
Create the overall testing schedule and align testing activities with configuration, migration, integrations, and deployment milestones.
Coordinate test case development based on approved business and system requirements.
Ensure requirements traceability from requirements ? test cases ? execution ? defects ? resolution.
Coordinate testing across functional areas, including UM, CM, Appeals integrations, data, workflows, security, and reporting as applicable.
Lead System/Functional Testing and ensure configured functionality performs as expected.
Coordinate integration testing with internal and vendor teams.
Plan and oversee migration/data validation testing, including reconciliation and data quality checks.
Coordinate end-to-end testing across connected systems and business processes.
Lead UAT preparation, including test scenarios, test data, business testers, schedules, and readiness.
Manage defects — establish severity/priority, assign ownership, track resolution, and ensure retesting.
Monitor testing progress and metrics, such as test execution, pass/fail rates, defects, blockers, and outstanding risks.
Escalate testing risks and blockers that could affect implementation milestones.
Coordinate defect triage meetings with BA, Clinical Leads, configuration, technical, integration, and business teams.
Validate fixes and regression testing after configuration changes, patches, or defect resolution.
Define and enforce entry/exit criteria for each testing phase.
Provide testing status reports to the PM/implementation leadership team.
Maintain testing documentation, including test plans, test cases, evidence, defect logs, and sign-offs.
Drive go-live testing readiness and provide a formal testing recommendation/readiness assessment.
Support post-go-live validation, including smoke testing and critical business-process validation.

Immediate priorities:

- Review the Test Strategy left behind
- Inventory all existing test cases/scenarios
- Meet with Program testing leads
- Map testing to the implementation milestones
- Identify what has been tested by clinical leads vs. what remains
- Review open defects and blockers
- Confirm upcoming testing dates and resources
- Identify gaps in test data/environment/integrations
- Establish testing status and metrics

Confirm UAT and go-live readiness criteria

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10529458
Position Id: 25795
Posted 1 hour ago

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