Client Solutions Manager- Care Management & Utilization Management

Abacus Insights is a mission-driven technology company focused on transforming the healthcare data industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights. In addition, our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met. 

With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to data that has been historically siloed and inaccessible. Through our platform, these healthcare organizations can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs.   

Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms with deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in a sector that is not only ready for disruption. We're growing quickly and would love for you to be a part of it! 

About the Role:  

We are seeking an experienced professional with operational experience and business subject matter expertise in Care Management and Utilization Management operations to join our client solutions team.  The successful candidate will lead the requirements gathering, analysis and identifying ways our clients can leverage the Abacus Insights product suite to improve a client’s business outcomes.   

Within the CM and UM data space you will: 

• Client Solutions Requirements Management: Develop business requirements in the form of use cases that capture the client’s requirements.  Work with client’s designated subject matter expert to understand business requirements and gather into a Business Requirements Document (BRD). This may include elaborating on requirements with the client, capturing acceptance criteria, assessing product fit to client’s needs, and identifying non-functional requirements. Requirements scope can vary across a broad range of client deliverables including, but not limited to, visualizations, reports, dashboards, data extracts or views into the data used by the client for operations or analytics. 
• Operational Expertise: Use your operational experience and knowledge in UM and CM and related data to triage business requests and requirements.
• Requirements Validation: Perform a set of tests against the delivered solution and confirm all acceptance criteria are met before turning over the solution to the client. This is a validation step performed by the author of the business requirements with assistance from other team members to simulate the actual client user acceptance testing (UAT) as a precursor to the client’s actual UAT. This activity compliments core testing performed by the Abacus QA team. 
• User Acceptance Testing: Laise with the client and partner with team members to coordinate and progress the client’s UAT.
• Customer Relationship Management: Partner with Account Management, Program Management, Sales, and Product Management to develop strong customer relationships, resulting in reference customers.
• Awareness of Product Capabilities: Become educated and understand the strategy of new product launches, new features, and product upgrades, and how they support the client.
• Collaboration and Coordination: Work closely with cross-functional teams, including business experts, technical business analysts, project managers, account executives and data engineers to successfully implement client projects.  Collaborate with Product Management to identify client-specific requirements that may translate into an existing standard product feature or a future feature on the product roadmap.
• Training and Support: Provide training to internal teams on business needs and use cases for seamless client implementation. Provide ongoing support to address questions and issues raised by the implementation team. 
• Cross-Functional Communication: Serve as a bridge between the client and Abacus technical teams, effectively communicating business requirements to team members. 
• Change Management: Own and manage all net new requests from client, tracking resolution using internal project management tool.
• Process Improvement: Conduct process analysis, process evaluation, and implement process improvements that lead to better solutions and client satisfaction. 

What we’re looking for: 

The ideal candidate will be organized, self-motivated, and able to complete complex tasks with little supervision.The Client Solutions Manager will be encouraged to remain current with market trends by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations. The Manager will be required to work with internal and external departments and able to position products, solutions, and services to be highly competitive to address client needs. 

• 8+ years of CM and UM data domain expertise within a Payer or Payvider with demonstrated success driving client-facing conversations and navigating payer organizations to identify requirements. 
• Operational experience in CM and UM in a Medicare or Medicaid plan.
• Strong working knowledge of US healthcare data including but not limited to Medical Claims, Pharmacy Claims, Eligibility, Plan, Enrollment, Clinical, and Provider, with a strong focus on Clinical data.  
• Understanding of CMS 0057 ePA (electronic Prior Authorization) ruling and its impact to payer CM operations.
• Understanding of EMR/EHR data.  Concepts of FHIR resources is a plus.
• Strong understanding of healthcare industry trends, regulations, and customer needs..
• Demonstrated experience industry standard UM/CM software like CareAdvance, ZeOmega, or other vendor UM/CM platform.
• A successful candidate has experience and practical knowledge for solutions to support payer clients in the following areas: 
• Experience using Care Management and Utilization Management applications for managing authorizations, cases, and utilization.
• Ability to interpret contractual agreements with State agencies and implement the necessary business processes and systems to support them.
• Understanding the role of data in improving patient outcomes and member experience.
• Practical understanding of quality measures and gap closure. 

Nice-to-Have: 

• Operational experience working at a Payer or Payvider managing or contributing to CM and UM processes, and able to articulate business requirements in an organized manner.
• Previous consulting experience 

Equal Opportunity Employer

As a mission-led technology company that drives better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers come from diverse ideas, thoughts, experiences, and perspectives. Therefore, we proudly dedicate extensive time and resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment of any race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.