Job Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Director, Enterprise Applications, leads the Enterprise Applications organization, including Health Plan Applications (HPA), Enterprise Salesforce/Applications, Application Development, and Enterprise Architecture. The Director's first priority is to unify and transform the HPA teams into a single, integrated function with clear ownership of core system configuration and accuracy, including but not limited to claims, benefits, enrollment and care management systems. The Director provides strategic and operational leadership for the enterprise application portfolio, aligns application configuration, development and architecture with health plan business priorities and regulatory requirements, and ensures teams organize, prioritize and complete work with appropriate oversight controls, reporting and quality assurance in place.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

· Leads and transforms the Health Plan Applications (HPA) teams into a single, integrated function with clear IT and business ownership, defined roles, and a sustainable operating model for core system configuration

· Drives quality, timely system configuration and maintenance of core health plan systems (e.g., QNXT, care management, enrollment) to allow the health plan to achieve regulatory compliance, robust financial management and product strategy outcomes

· Oversees, develops, and maintains documentation for claims and benefit configuration processes and procedures with appropriate controls, reporting and quality assurance

· Develops robust testing protocols; supports regular audits and quality checks to ensure configuration accuracy, data accuracy and system performance

· Leads the Application Development team in the design, build, and support of custom applications and system integrations, applying Software Development Life Cycle (SDLC), DevOps and secure development standards

· Provides leadership for the Enterprise Salesforce/CRM platform, including platform ownership, administration, release management and applications support, in partnership with business stakeholders

· Partners with Enterprise Architecture to ensure application solutions align with enterprise standards, the technology roadmap, and integration and data strategies

· Develops work intake mechanisms across Enterprise Applications teams, exploring and implementing tools to manage inventory of tickets, prioritize backlog and assess different work types (i.e., reporting, configuration, development, project vs. production fixes, etc.)

· Delivers strong vendor oversight to optimize system processing to improve efficiency and accuracy; pursue new vendor opportunities including Request for Information (RFI)/Request for Proposal (RFP) as deemed appropriate

· Collaborates with business, Operations, Data & Analytics and IT teams to ensure system and operational readiness for system fixes, configuration, and project rollouts

· Collaborates with infrastructure and integration teams to ensure system upgrades, enhancements, integration updates and file loads are coordinated and implemented

· Manages the Enterprise Applications budget, staffing plan and vendor spend; tracks performance against key metrics and service levels

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

POSITION QUALIFICATIONS

Education:

• Bachelor's degree required
• Master's in Business Administration, Information Systems, or comparable advanced degree strongly preferred

Licensure/certification:

• Project management (PMP), Agile/SAFe, ITIL, or Salesforce certification preferred

Experience:

• 10+ years health plan or healthcare information technology experience, including 5+ years leading application, configuration, or development teams required
• Experience managing vended core system applications required
• Demonstrated experience leading organizational change and transforming team operating models required
• Experience with test plan development, strategy, and execution required
• Experience with Cognizant (TriZetto) QNXT configuration, administration, or implementation strongly preferred
• Experience leading application development teams (custom development, integrations, SDLC) preferred
• Familiarity with Salesforce or other CRM platforms preferred
• Experience supporting Medicare Advantage and/or TRICARE lines of business preferred

Knowledge:

• Maintains knowledge and understanding of reimbursement agreements as well as claims and billing practices that impact cost and utilization data
• Knowledge of industry standards for claims and enrollment configuration, reporting and analysis
• Knowledge of benefit coverage and servicing members, providers, and the DoD, CMS/ Medicare Advantage, and ME state insurance coverage
• Knowledge of managed care computer systems, features, and reporting
• Knowledge of CMS interoperability requirements (e.g., CMS-0057-F) and healthcare data standards (HL7 FHIR, X12 EDI) preferred
• Knowledge of Agile delivery practices and IT service management (ITSM) preferred

Skills:

• Excellent workflow and inventory management skills
• Demonstrated interpersonal, communications, operational, team building, and quality improvement skills
• Strong leadership, coaching and change management skills, with the ability to unify teams around shared goals
• Ability to communicate effectively with executive leadership and translate business needs into technology solutions
• Proficiency with work management and ticketing tools (e.g., Jira, ServiceNow, Azure DevOps) preferred

Abilities:

• Demonstrates an understanding of and alignment with Martin’s Point Values
• Develops and maintains positive, effective working relationships with colleagues, vendors, and other internal and external customers
• Excellent problem solving, quantitative and analytical skills with the ability to assess performance against metrics
• In-depth technical knowledge and ability to learn new technologies; knowledge of the Software Development Life Cycle (SDLC)
• Ability to manage, organize, and prioritize workload in a timely accurate manner.
• Ability to manage multiple competing demands and function independently
• Critical thinking: can identify root causes and implement short- and long-term sustainable solutions

In compliance with MPHC’s Department of Defense contract, all persons hired for this position will need to verify their U.S. citizenship and complete the required employment eligibility verification upon hire.

Pay Range: $165,546.85 - $204,499.05 To promote pay equity, Martin’s Point Healthcare has established defined salary ranges for each role. Compensation is established within the posted range based on a variety of factors, including relevant years of experience, current market conditions, internal equity, and budget considerations. The pay range reflects the potential compensation for this role based on a full-time position. Employees may also be eligible for additional compensation, such as incentive or commission-based programs, where applicable and subject to the terms of the applicable plan. Final compensation is determined at the conclusion of the interview process. We encourage you to apply even if your desired compensation falls outside of the listed range. In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org