Business Consultant Clinical SME

The Business Consultant Clinical SME is responsible for supporting the implementation of new clients as well as ongoing client production support for the MHK CareProminence solution suite.  Bringing prior experience as a nurse, this role serves as the bridge between the client and the MHK customer operations teams for implementation, production support, development, configuration, quality assurance, product documentation, and compliance. This role also provides product design direction throughout the customer lifecycle to ensure a consistent customer experience while maintaining the integrity of the MHK solution design for the customer.  The ideal candidate has the passion and desire to foster 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 and production support of MHK software solutions for Utilization Management, Care Management, Medical Appeals & Grievances (MHK clinical solutions) as a subject matter expert to ensure the success of our clients.
• Define product content, workflows and service level agreements required to meet client requirements, as well as the regulatory and accreditation requirements of the industry. 
• 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 module testing for MHK clinical solutions to ensure accurate functionality prior to releasing to internal models and/or new revision releases.
• Identify problems within the MHK clinical solutions and communicate them through established change management process.
• Provide solutions approvals as required by the release management process.
• Perform other duties as assigned by the Manager. 

Required Qualifications:

• Five (5) years of experience within health plan or PBM within one or more of the following areas Utilization Management, Care Management, Medical Appeals and Grievances.
• Strong understanding of the healthcare industry and experience working with/knowledge of CMS, NCQA, URAC and other health plan accreditation and regulatory compliance.
• Previous experience with leveraging technology solutions to support health plan or PBM operations, supporting software solution implementations, and defining user requirements.

Preferred Qualifications:

• Experience leveraging evidence-based guidelines (e.g. MCG, InterQual) for making medical necessity determinations.
• Experience with performing case management assessments and developing care plans to improve member outcomes.
• Ability to adapt to competing demands, take on new responsibilities, and adjust plans to meet shifting priorities.
• Ability to maintain a positive, constructive approach to problem solving internally and during customer interactions with focus on timely and accurate issue resolution.
• Previous experience translating business requirements into system configuration.
• Previous “Scrum” based product development experience in SaaS environment, including hands-on active participation in production support, implementations, and projects.
• Previous experience performing detailed market, competitive, customer needs and software product feature analysis.
• Previous experience defining, building, and executing test cases.
• Experience presenting and communicating with all levels of organizations.
• Excellent written, verbal communication and interpersonal skills.
• Proficient with Jira, Word, Power Point, Excel, and Document Management tools

Education/Licensure Requirements:

• Bachelor Degree in Nursing (BSN) 
• Active RN license required; will consider Licensed Practice Nurse (LPN) with similar level of experience. 

Additional Requirements:

• Ability to work on Eastern Time Zone (EST)
• Occasional travel to support client projects. 
• Ability to sit for extended periods of time.   

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. 

COMMITMENT TO DIVERSITY & INCLUSION:

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