Sr. Consultant, Quality Control

Sr. Quality Improvement ConsultantNavitus Health Solutions is seeking a Sr. Quality Improvement Consultant to join our team The Sr. Quality Improvement Consultant is an integral part of the Claims Quality Assurance & Testing (QAT) team which performs multiple functions in quality control and quality improvements with a goal to ensure the accuracy of benefit plan configuration in the NavicareRX system for the entire enterprise. They are responsible for ensuring that internal process adherence is met for all lines of business and all departments. This position will be responsible for partnering with business partners and implementing a work management tool that feeds information to the Claim Adjudication Operations teams. The QAT team reviews the client's requirements at implementation to determine client intent and audit approach to gain the expected outcome. This position will collaborate with the Implementation, Account Management, Compliance, and IT teams. This position will utilize system expertise, client documentation, claim adjudication rules, and QAT team processes and procedures to effectively identify coding errors and identify trends to improve processes.Is this you? Find out more belowResponsibilitiesHow do I make an impact on my team?Executes on assigned Quality Process Improvement projects and quality initiatives, including leading work management project, heat mapping project, and roadmapsAbility to organize information, learn complex technologies and explain concepts and instructions clearly and concisely to all levels of employeesInitiates process improvements, root cause analysis, preventative action implementation, metrics, automation, training, documentation, and complianceWorks with Quality Leader and business partners to clearly define new client implementation testing processes for the enterpriseAttends workgroup meetings to improve upstream processes related to requirements and work management toolsCreates and maintain quality test case templates, workbooks, job aids and provide training for any tools created in this roleAnticipates customer needs and proactively develops solutions to meet them. Attend client implementation calls representing Quality regarding testing and validation to ease client concernsIdentifies patterns, trends, and relationship of data to Forecast and plan resource requirements along with Quality Leader. Create and maintain the Quality Team's C2D (Capacity to Demand) which assists with forecasting and participate in client implementation FTE planningAuthorizes deviations from standards. When working with Health Plan accounts there are many different challenging scenarios, especially in validation. The standard way that works for an account with 10 plans might not work for an account with 29,000 plan codes. You need to be creative and think outside the box to complete the audit efficiently and accuratelyOther duties as assignedQualificationsWhat our team expects from you? College degree or work experience equivalent10+ years of relevant work experience in the healthcare industry or demonstrated expertise with benefit configuration and testingExpert level experience using MS Excel filtering, sorting, and analyzing data with ability to write complex Excel formulasMinimum eight years of experience in leading and implementing process improvement initiativesMinimum eight years of experience in the health care industry, or equivalentKnowledge and demonstrated experience with usage of industry standard tools for managing projects and quality improvement initiativesExperience in creating a heat map and identifying quality gaps for an entire enterpriseMinimum 8 years' experience in a client facing role with the ability to articulate the PBM process and answer client questions related to quality controlsParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus? Top of the industry benefits for Health, Dental, and Vision insurance20 days paid time off4 weeks paid parental leave9 paid holidays401K company match of up to 5% - No vesting requirementAdoption Assistance ProgramFlexible Spending AccountEducational Assistance Plan and Professional Membership assistanceReferral Bonus Program up to $750Location: RemoteLocation: US