Specialty/Competency: Operations

Industry/Sector: Health Services

Time Type: Full time

Travel Requirements: Up to 80%

A career within Functional and Industry Technologies services will provide you with the opportunity to build secure and new digital experiences for customers, employees, and suppliers. We focus on improving apps or developing new apps for traditional and mobile devices as well as conducting usability testing to find ways to improve our clients’ user experience.

As part of our team, you’ll help clients harness technology systems in the healthcare industry focusing on areas such as electronic health records, policy administration, billing & benefits, revenue management, channel pricing and contracting.

To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.

As a Manager, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:

• Develop new skills outside of comfort zone.

• Act to resolve issues which prevent the team working effectively.

• Coach others, recognise their strengths, and encourage them to take ownership of their personal development.

• Analyse complex ideas or proposals and build a range of meaningful recommendations.

• Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.

• Address sub-standard work or work that does not meet firm's/client's expectations.

• Use data and insights to inform conclusions and support decision-making.

• Develop a point of view on key global trends, and how they impact clients.

• Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.

• Simplify complex messages, highlighting and summarising key points.

• Uphold the firm's code of ethics and business conduct.

The Application Lead is responsible for day-to-day implementation oversight, bringing past Epic Tapestry implementation and Payer operations experience for each of the following areas:

• Tapestry Membership (includes CRM - Epic Cheers)

• Core Administration (i.e., Epic Claims)

• Medical Management/UM

• Case Management (Epic Compass Rose)

Job Requirements and Preferences :

Basic Qualifications :

Minimum Degree Required :

Bachelor Degree

Minimum Years of Experience :

5 year(s)

Preferred Qualifications :

Degree Preferred :

Master Degree

Preferred Certifications:

Epic Tapestry

Epic Cheers

Epic Claims

Epic Compass Rose

Preferred Knowledge/Skills :

Demonstrates extensive-level abilities and/or a proven record of success with an understanding of managing client engagements and producing solutions that involve, the following areas:

• Working experience across payer operations, specifically to drive transformation across core functions and technology implementations;

• Possessing experience within domain areas that include: claims, enrollment, billing, membership, provider data, product management, and related functions;

• Possessing experience with either process level familiarity and/or familiarity with the technology solutions that enable these functions;

• Working experience with Operations and administration of Healthcare/Payer, Product and Services businesses;

• Working experience with trends of global organizations utilizing pragmatic approaches to achieve sustainable financial functions and operating models;

• Understanding the latest industry trends and regulatory changes, and their impact to organizations;

• Having knowledge of assessment of healthcare payer (and provider-owned plans) operating models, including strategy, capabilities, operational performance and governance models;

• Understanding quality reporting requirements; and,

• Benchmarking to compare healthcare payer performance and costs to leading practice, including operational results, productivity, and quality metrics.

Demonstrates extensive experience with large Epic Tapestry platform implementations, including managing teams to drive successful implementation

• Serving as project manager for multiple projects, creating timelines and cost projections, and ensuring projects comply with specifications, timelines, and budgets;

• Leading all aspects of Epic Tapestry systems implementation (planning, build, test, train, implement, production support); and,

• Bring leading industry practices and key insights from prior experience with Epic Tapestry implementations.

Demonstrates extensive-level, abilities success with managing the identification and addressing of client needs:

• Building, maintaining, and utilizing networks of client relationships and community involvement;

• Communicating value propositions, utilizing PC applications such as Microsoft Office Suite or Google Tools to write and deliver proposals to prospective clients;

• Managing resource requirements, project workflows, budgets, billing and collections; and,

• Preparing and/or coordinating complex written and verbal materials.

Demonstrates extensive abilities and/or a proven record of success as a team leader by:

• Supervising teams to create an atmosphere of trust and seeking diverse views to encourage improvement and innovation;

• Answering questions and providing direction to less experienced staff;

• Coaching staff including providing timely meaningful written and verbal feedback;

• Developing, writing, presenting and facilitating discussions on strategy to all levels of industry audiences, clients and internal staff and management;

• Understanding of healthcare payer operations, terminology, technology platform and environment;

• Having healthcare payer or related consulting experience; and,

• Possessing experience with common business and data tools (including Microsoft Office Suite, Google Tools, Alteryx, Tableau).

Learn more about how we work: https://pwc.to/how-we-work

PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.

All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer.

Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines

The salary range for this position is: $100,000 - $232,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance

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