Client Solutions Manager, CM & UM

Summary

Join Abacus Insights, a mission-driven technology company transforming healthcare data, as a Client Solutions Manager. You will lead requirements gathering and analysis, leveraging Abacus's product suite to improve client business outcomes. This role requires deep expertise in Care Management and Utilization Management (CM/UM) operations within the payer space. You will work closely with clients, internal teams, and cross-functional departments to ensure successful project implementation and strong customer relationships. The ideal candidate possesses extensive CM/UM data domain expertise, a strong understanding of US healthcare data, and experience with industry-standard software. This is a high-impact role contributing to Abacus's continued growth and success in revolutionizing healthcare data.

Requirements

• 8+ years of CM and UM data domain expertise within a Payer or Payvider with demonstrated success driving client-facing conversations and navigating payer organizations to identify requirements
• Operational experience in CM and UM in a Medicare or Medicaid plan
• Strong working knowledge of US healthcare data including but not limited to Medical Claims, Pharmacy Claims, Eligibility, Plan, Enrollment, Clinical, and Provider, with a strong focus on Clinical data
• Understanding of CMS 0057 ePA (electronic Prior Authorization) ruling and its impact to payer CM operations
• Understanding of EMR/EHR data.  Concepts of FHIR resources is a plus
• Strong understanding of healthcare industry trends, regulations, and customer needs
• Demonstrated experience industry standard UM/CM software like CareAdvance, ZeOmega, or other vendor UM/CM platform
• Experience using Care Management and Utilization Management applications for managing authorizations, cases, and utilization
• Ability to interpret contractual agreements with State agencies and implement the necessary business processes and systems to support them
• Understanding the role of data in improving patient outcomes and member experience
• Practical understanding of quality measures and gap closure

Responsibilities

• Develop business requirements in the form of use cases that capture the client’s requirements
• Work with client’s designated subject matter expert to understand business requirements and gather into a Business Requirements Document (BRD)
• Elaborate on requirements with the client, capturing acceptance criteria, assessing product fit to client’s needs, and identifying non-functional requirements
• Use your operational experience and knowledge in UM and CM and related data to triage business requests and requirements
• Perform a set of tests against the delivered solution and confirm all acceptance criteria are met before turning over the solution to the client
• Laise with the client and partner with team members to coordinate and progress the client’s UAT
• Partner with Account Management, Program Management, Sales, and Product Management to develop strong customer relationships, resulting in reference customers
• Become educated and understand the strategy of new product launches, new features, and product upgrades, and how they support the client
• Work closely with cross-functional teams, including business experts, technical business analysts, project managers, account executives and data engineers to successfully implement client projects
• Collaborate with Product Management to identify client-specific requirements that may translate into an existing standard product feature or a future feature on the product roadmap
• Provide training to internal teams on business needs and use cases for seamless client implementation
• Provide ongoing support to address questions and issues raised by the implementation team
• Serve as a bridge between the client and Abacus technical teams, effectively communicating business requirements to team members
• Own and manage all net new requests from client, tracking resolution using internal project management tool
• Conduct process analysis, process evaluation, and implement process improvements that lead to better solutions and client satisfaction

Preferred Qualifications

• Operational experience working at a Payer or Payvider managing or contributing to CM and UM processes, and able to articulate business requirements in an organized manner
• Previous consulting experience