Anticipated End Date:

Position Title:

Business Consultant

Job Description:

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles or a 1-hour commute each way of one of our Elevance Health PulsePoint locations.

Schedule: Monday-Friday 8am-5pm EST . 4 days virtual , 1 day at the designated pulse point.

Responsible for translating moderately complex and varied business needs into business requirements with technical impacts. Possesses full technical knowledge of most phases of project life cycles, including systems and business impacts, and is able to consider the business implications of the application of technology to current and future business environments.

PRIMARY DUTIES: 

• Lead discovery and requirements refinement sessions to uncover customers’ business, functional requirements and synthesize requirements to create clear and comprehensive high level and detail business requirements with acceptance criteria.
• Analyzes complex end user needs to determine optimal means of meeting those needs.
• Determines specific business application software requirements to address complex business needs.
• Prioritize multiple efforts including but not limited to mandates, implementations, and operational support across multiple lines of business for both pharmacy and medical injectable (specialty pharmacy) benefits.
• Develops requirement traceability metrics enabling traceability to both the project plan and test plan.
• Partner with cross functional teams – business, programming, and testing staff to ensure requirements will be incorporated into system design and testing.
• Utilize Blueprint requirements management tool to document business requirements, obtain stakeholder signoff, and manage requirements through project lifecycle end to end processes ensuring smooth transition and requirements traceability to technical partners.
• Acts as a resource to users of the software to address questions/issues for multiple prior authorization platforms.
• Acts as a resource supporting BPL formulary crosswalk mapping for GRS clients and Medicare Product Launch (MPL).
• Provide direction and guidance to team members and serves as an expert for Legal/Executive/Regulatory Decision Special Handling Instructions requirements.
• Provide direction and guidance to team members and serves as an expert of prior authorization requirements including workflows, letters, timers, reporting, and electronic PA processes.

 

REQUIREMENTS:  

• Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.
• Knowledge of systems capabilities and business operations is strongly preferred.
• Knowledge of Service Now and Blueprint Business Capability Model (BCM) integration
• Knowledge of PBM Domain and Capability Architecture supporting BCM
• Ability to write Capability Incremental Statements (CISs) supporting BCM
• Requires minimum of 5 years of pharmacy Experience

PREFERRED QUALIFICATIONS: 

• PBM and pharmacy knowledge preferred.
• Knowledge of requirement management tool Blueprint strongly preferred.
• Prior authorization experience strongly preferred.
• Experience with multiple membership demographics including Medicaid, Medicare, GRS, Commercial, and MEWA strongly preferred.
• Experience with retail pharmacy and medical injectable (specialty pharmacy) benefits and nuances strongly preferred.
• Experience working with mandates and regulatory business units strongly preferred.
• Knowledge of Agile/Safe practices preferred.
• Knowledge of systems capabilities and business operations strongly preferred.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

BSP > Business Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.