Sr Business Solutions Consultant - QNXT SME - Remote

$88,453 - $206,981/Yr

Molina Healthcare - Layton, UT

Full-time

Remote - Layton, UT

Insurance Carriers and Related Activities

About the position

The Sr Business Solutions Consultant - QNXT SME is a strategic leader responsible for managing relationships and providing process expertise within Molina Healthcare. This role focuses on enhancing operational efficiencies and customer satisfaction through business process improvement initiatives, while collaborating with health plan leadership, corporate leadership, and IT operations partners.

Responsibilities

• Builds, manages and maintains effective business relationships with key stakeholders across health plans and corporate healthcare functions.
• Focus on process analysis and re-engineering, understanding technical problems and solutions in the business environment.
• Drives process change by integrating new processes with existing ones and communicating these changes to impacted teams.
• Uses quantitative and qualitative analysis to develop and improve internal processes across the enterprise.
• Recommends and facilitates process improvement efforts, leading re-engineering teams and acting as project manager when necessary.
• Documents ways to increase efficiency through continuous improvement goals and process maturation, considering budget impacts.
• Maintains management/technical skills to solve complex problems in the field.
• Continuously improves established reports to ensure best performance and business value metrics.
• Demonstrates tools, techniques, and communication skills to build effective business relationships.
• Works closely with corporate leadership to deliver key business initiatives and manage KPIs.
• Documents business needs for project requests and benefit value documentation, including compliance implications and cost-benefit analysis.
• Responsible for business case development and advising on project benefit calculation drivers.
• Demonstrates advanced knowledge of business work pipeline, IT roadmap, and required interactions for portfolio management processes.
• Organizes complex project requests into manageable approaches and advises on project setup based on proposed scope.
• Facilitates groups for problem solving and service improvement, including business workflow analysis.
• Develops effective processes and tracking mechanisms to improve processes through business feedback and complaint resolution.
• Conducts bi-weekly operations and issue resolution meetings.
• Develops and maintains a service delivery plan for health plans or corporate functions, including strategies and performance measurements.
• Effectively manages business escalations with accountability and communication.
• Knowledgeable of State Medicaid contract Service Level Agreements and MCO contract compliance requirements.
• Facilitates processes impacting assigned health plans, including RFP responses and audit coordination.
• Remains knowledgeable of vendor strategic roadmaps and aligns them with business growth.
• Arranges vendor demonstrations and manages proof of concept requirements.

Requirements

• Bachelor's Degree in Business, Healthcare, Computer Science, Information Systems or 10 years of related field or equivalent experience.
• 7-10 years of business function or relations management experience.
• 5-7 years of IT or system delivery or related experience.
• 3 years of strategic planning experience.
• Project management background.

Nice-to-haves

• Master's Degree in Computer Science, Information Systems or Healthcare related field.
• 3+ years of management experience.
• 3-5 years of managed care experience.

Benefits

• Competitive benefits and compensation package.