Enterprise Project Manager - Executive - Quality Assurance Analyst

Location: Columbia

Title: Enterprise Project Manager
- Executive
- Quality Assurance Analyst
Location: Columbia SC 29201
On-site/Remote/Hybrid: Hybrid (3 days in office, 2 days remote) after 30-90 days fully onsite
Duration: 12 Months
Interview Process: 1 round Virtual/Online
No of submissions: 2
No of Positions: 1

Scope: The Eligibility and Enrollment Member Management Project is one of the largest IT projects for the State of South Carolina. It focuses on SCDHHS Medicaid Eligibility system. This project will be very complex and will demand exceptionally high quality team members.

Job Description:
DAILY

DUTIES / RESPONSIBILITIES:

The Quality Manager is responsible for a PMI-oriented approach and methodology to ensuring DDI (Design, Development, and Implementation) process conformance, as well as assisting in monitoring and controlling the quality of project deliverables.

Duties include:

• Understanding of solution requirements, monitoring development execution, and performing validation of deliverables against original requirements as expressed in a requirements traceability matrix.

• Assist the Project Management Organization in the design and implementation of templates relating to quality management processes to be used as organizational process assets throughout SC DHHS projects.

• Assist project director and project manager in the development of technical metrics for compliance with industry best practices and standards as defined by CMS and the 'MITA-Mature' Medicaid Information Systems suite of standards.

• Documenting and analyzing agency business processes and recommending improvements.

• Documenting and analyzing data requirements and relationships.

• Participating in the requirements management processes, including change control, version control, tracking and status reporting, and traceability.

• Providing requirements interpretation and guidance to test teams.

• Proactively identifying risks, issues, and action items leading to possible solutions; risk resolution techniques highly desired, including mitigation, transference, avoidance, and where required, acceptance.

• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).

• Consolidating defect tracking and resolution efforts of the User Acceptance Team lead and respective staff, developing testing activity protocols, and developing techniques and standards for use in defect tracking and resolution.

• Planning for, conducting, and reporting on testing and other quality assurance activities.

• Support activities to gain approval for certification for the system from state and federal partners.

• Help identify project schedules to ensure all dependencies from a testing and logistics perspective are accounted for.

Other duties as assigned.
Subject matter areas include member related eligibility determination, enrollment and disenrollment, eligibility inquiry, capitation premium payment, health insurance premium payment, Medicare premium payment, premium invoice, program policy, and state plan.
Familiarity with the Affordable Care Act and impacts on Medicaid eligibility and member related processes is also beneficial

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 3+ years of Quality management experience on major IT healthcare systems development

• 3+ years' experience in healthcare insurance IT software/systems implementations performing
duties described in the "Daily Duties/Responsibilities” section above.

• Experience using modern commercial rules engines and their respective orchestration layers.

REQUIRED EDUCATION:
Bachelor Degree or equivalent experience;
Master's Degree preferred.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• Medicaid eligibility system/business operations experience

• Understanding of the Medicaid Information Technology Architecture (MITA)

• Understanding of the Medicaid Enterprise Certification Toolkit (MECT)

• Experience in an outsourced IT development project.

ADDITIONAL DUTIES/ SKILLS:

• Ability to properly document quality audit and monitoring and controlling activities.

• Ability to interpret business process and business data models.
•…