Senior Consultant

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Job Discription:
Consultant Senior
Generally operating in a non-routine and strategic capacity, works with senior management to evaluate existing systems and/or end-user needs to design and recommend an optimal strategic direction for business systems. Conclusions made are objective, logical and based on facts that have been carefully collated and verified. Recommendations, however, are subjective and based on the consultant's background and experience. Knowledgeable of a broad range of healthcare-related business and/or IT concepts, practices, and procedures. May lead and direct the work of others with capabilities to manage very large projects. Frequently reports directly to an executive. Creates value for an organization through the application of knowledge, techniques, and assets to improve business performance. Provides objective appraisals as an expert outsider who provides a broader picture perspective. Typically required to summarize and present findings to executive levels. A wide degree of creativity, independence, and latitude is expected. Some knowledge of BCBSM/BCN technologies and/or business verticals is expected. Engagements are typically no longer than 3-6 months. Bachelor's degree is required. Masters degree is not required but expected. A minimum of 10-15 years of experience in business/IT consulting roles within large corporations preferred. Also per the customer's specific request: Expertise in hospital/medical plan administration:
¿ Experience with working with administrator and project manager(s) in issues related to:
o Self-funded plans
o Enrollment
o Eligibility, including 834 file (full and change file) review
o Deployment of new CMS-compliant programs
o Federal Subsidy enhancement opportunities
¿ Experience in Medicare Advantage product administration oversight, including:
o CMS regulations regarding adherence:
¿ Communications
¿ Wellness Programming
¿ Enrollment and Eligibility
¿ Working and building relationships with industry expertise, including but not limited to recognizing the need to assemble subject matter expertise in collaboration on resolution, in conjunction with Project Manager(s), while maintaining client communication and input.
Expertise in pharmacy benefits administration:
¿ Self-funded plans, including plans that have separate administration for hospital/medical coverage and pharmacy coverage
¿ Experience in Part D (Pharmacy) product administration oversight, including:
o CMS regulations regarding adherence:
¿ Formulary development, submission, changes, and timing(s)
¿ Communications
¿ Enrollment and Eligibility
¿ Federal coverage guidelines, including the 3 coverage stages and PPACA¿s impact to each
¿ Collaboration with industry expertise
¿ Working and building relationships with industry expertise, including but not limited to recognizing the need to assemble subject matter expertise in collaboration on issue resolution, in conjunction with Project Manager(s), while maintaining client communication and input.
Other:
¿ Experience and knowledge in the following:
o Vision
o Dental
o HMOs
o Fully insured product administration and/or development
o Self-insured product administration and/or development
o Insurance premiums rate setting
o Medicare base products (Parts A & B)
o Medicare Advantage (Part C)
o Prescription Drug Plans (Part D)
o Federal and State Exchanges
This position is to fill the open position left by Michele Bartley under the prior req number 1000008083. This is the health care consultant position as defined by the current medical contract and the position is located onsite at the customer's office inLansing,MI...The first round of candidates are to be interviewed by the Key State Accounts team and the second and final interview will be conducted by the customer onsite at theirLansing,MIoffice location. The customer has the final approval. Candidates must match talent and experience to anticipated bill rate/pay rate ratio...
Vineet Kumar
Acro Service Corp.
Web: ****

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