Health Plan Senior Clinical SME Specialist Job in Berwyn, Pennsylvania US

Health Plan Senior Clinical SME Specialist

Job Title: Senior Clinical SME Specialist CSC is a global leader in providing technology-enabled solutions and services through three primary lines of business. These include Business Solutions Services, the Managed Services Sector and the North American Public Sector. CSC's advanced capabilities include system design and integration, information technology and business process outsourcing, applications software development, Web and application hosting, mission support and management consulting. The company has been recognized as a leader in the industry, including being named by FORTUNE Magazine as one of the World's Most Admired Companies for Information Technology Services (2010). Essential Qualifications: CSC has immediate opportunities for senior clinical SME process specialist. This resource must have a broad knowledge of all aspects of healthcare with a deep understanding of clinical processes as it relates to ICD/10 in a payer setting. This resource must have extensive experience in clinical processes relating to the health plan domain, process design, and consulting. Essential Job Functions: Responsibilities Review the current ICD-9 related clinical process and assess impact of ICD-10 on the clinical processes. Facilitate JAD sessions with the client, including participants from benefit configuration, provider, provider reimbursement, finance, claims processing and medical policy. Develop the process and approach to migrate managed care clinical impacting processes to support ICD-10. Provide thought leadership to the client regarding leading practices, tools and methods available to support ICD-10 process efforts. Conduct impact analysis of process redesign on existing organization roles, principles, facilities and technical infrastructure and guides others to understand the impact Identify and present gap analyses highlighting current state, future state, client needs, best practices and competition. Participate in the integration and deployment activities relevant to the organizational change discipline (i.e., training, rewards / recognition, communication plans etc.) Participate in project quality assurance of logical models in business process, data, location and organization Lead a team of 6-10 resources (company, client and third-party resources) in area of expertise to conclusion of a project phase. Work in conjunction with technologists to define application systems that enable business processes and ensure that the redesigned processes are feasible with existing and new technologies. Manage client expectations and balance the needs of the company and the client to ensure satisfaction for both. Influence decisions and project direction at the executive level. Perform consultative selling and leverages business through superior delivery skills, client relations and subject matter expertise. Participate in proposal efforts and sales calls. Provide leadership and work guidance to less experienced personnel. Skills/Experience: Deep Clinical subject matter experience as it relates to the health plan environment Consulting experience Experience with ICD-10 Business Process design experience. Basic Qualifications: Bachelor's degree or equivalent combination of education and experience in nursing or other clinical area Bachelor's degree in business, computer science or related field preferred Five or more years of consulting experience with business analysis, design, and redesign Experience working with CSC Catalyst and/or equivalent client-mandated methodology - is this realistic? Experience working with techniques and approaches for business process design Experience working with techniques and approaches for test planning and execution preferred Other Qualifications: One to two years of additional relevant experience in a particular business or industry specialty area Strong analysis and design skills Good communication skills Ability to manage competing priorities in a complex environment Ability to devise creative business solutions Ability to convey a strong presence, professional image, and deal confidently with complex business problems Willingness to travel Essential Job Functions Conducts impact analysis of process redesign on existing organization roles, principles, facilities and technical infrastructure and guides others to understand the impact (Business). Identifies and presents gap analyses highlighting current state, future state, client needs, best practices and competition (Business). Participates in the integration and deployment activities relevant to the organizational change discipline (i.e., training, rewards / recognition, communication plans etc.) (Business). Participates in project quality assurance of logical models in business process, data, location and organization (Methodology). Leads a team of 6-10 resources (company, client and third-party resources) in area of expertise to conclusion of a project phase (Management). Works in conjunction with technologists to define application systems that enable business processes and ensure that the redesigned processes are feasible with existing and new technologies (Technical). Manages client expectations and balances the needs of the company and the client to ensure satisfaction for both (Relationship Management). Influences decisions and project direction at the executive level (Relationship Management). Performs consultative selling and leverages business through superior delivery skills, client relations and subject matter expertise (Leverage). Participates in proposal efforts and sales calls (Leverage). Provides leadership and work guidance to less experienced personnel (Leadership). Communicates in formal presentation settings including medium to large sized groups of key decision makers at the executive level; tailors presentations to needs and interests of the audience. Develops articles and white papers covering areas of expertise (Communication). Qualifications Basic Qualifications Bachelor's degree or equivalent combination of education and experience Bachelor's degree in a related field preferred Six or more years of consulting experience with business analysis, design, and redesign Experience working with client mission, vision, and key performance requirements Experience working with business process redesign and process improvement concepts, issues, methods, and techniques Other Qualifications Two to five years of additional relevant experience in one or more business or industry specialty areas Strong workflow analysis and business process integration skills Strong communication skills Ability to deal with and resolve ambiguity Ability to anticipate problems and take decisive action, giving regard to the impact on both the client and the company Ability to adjust personal style to different situations Willingness to travel