Company :HM Health SolutionsJob Description : 

JOB SUMMARY

We are seeking a passionate and experienced Pega expert who will use their knowledge and skills to design as well as implement an industry-leading Clinical Care management platform. Candidate must have strong understanding of integration with external APIs, streaming data using Pega in conjunction with Confluent Cloud and implementation of Pega best practices. Incumbent should have experience with agile implementations using Pega Deployment Manager as well as a high degree of familiarity with the Pega community. You'll design and lead implementation of a multi-tenant Pega solution supporting Utilization Management, Case Management, and Disease Management, building automation and workflows to support automated prior authorizations, care plan management, and pharmacy reviews . You will lead a team to analyze the needs and the environment to make sure the solution considers the current architecture and operating environment, as well as future functionality and enhancements.

As a technical leader, you’ll identify new opportunities to create digital solutions and automations to help our providers, employers, and most importantly, our members meet their toughest challenges.

ESSENTIAL RESPONSIBILITIES

Provide technical leadership and expertise to support implementation and maintenance of industry-leading Care Management platform. Collaborate with architecture team, information security, Kafka streaming team, Enterprise Data, and API factory teams to provide the most complex architecture and technical designs including data mapping and process modeling in order to understand capability gaps or new requirements, particularly when onboarding new clients.  Recommend changes to the client based on this analysisProvide proofs of concept, code reviews, and implementations when necessary to support Prior Authorization and Care Plan management functions. Responsible for contributing to architecture runway, including coordination with user groups to identify solutions that improve business processes, implementing the most complex process and system changes, system training, and other user-focused activitiesProvide guidance and education to lower level employees.Act as escalation for highly complex Other duties as assigned or requested.

EDUCATION

Required

Bachelor's Degree in Information Technology or related field

Substitution

Bachelor's degree in Healthcare or related field with a minimum of 5 years in IT in application developer or related role. 

Preferred

Master's Degree in Information Technology or related field

EXPERIENCE

Required

7 years of Application Development experience

To Include:

3 years of Business Systems experience

Preferred

None

LICENSES/CERTIFICATIONS

Required

Pega Licensed System Architect

Preferred

Java DeveloperSAFe 5 AgilistEnterprise Architect (SCEA)Project ManagementScrum Master CertificationLean/Six Sigma Certification

SKILLS

IMS, DB2, Oracle and Teradata Databases, Data WarehousingJava/JavaScript FrameworkPEGA, CSS3, Mobile, JSON, Cognos, Hadoop, SQL, J2EE, HTML5/XMBusiness ObjectWaterfall, Agile, RationalAnalytical SkillsCommunication SkillsProblem-Solving Skills

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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