Client Solutions Manager - CM & UM

March 24

🍂 Massachusetts – Remote

Although this job is listed in Massachusetts, this company may be open to hiring remote in other states.

⏰ Full Time

🟠 Senior

🔴 Lead

💻 Solutions Engineer

🦅 H1B Visa Sponsor

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Abacus Insights

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Abacus Insights is a leader in health plan data solutions that empowers healthcare payers by providing usable and interoperable data. The company offers a comprehensive suite of data solutions designed to address complex government mandates and improve payer readiness. Abacus Insights' platform is capable of consolidating and normalizing diverse data sources into comprehensive patient records, ensuring data accuracy, and facilitating timely data updates. Their solutions support multiple use cases, including risk adjustment, clinical data exchange, cost management, and performance reporting. With a focus on technology and healthcare, Abacus Insights helps payers manage costs and improve member experiences through enhanced data management capabilities.

Healthcare • Data Management • Analytics • SaaS Platform • Healthcare Data Transformation

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

📋 Description

• Abacus Insights is a mission-driven technology company focused on transforming the healthcare data industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. • With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform. • Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms. We are solving problems of massive scale and complexity in a sector that is not only ready for disruption. • The successful candidate will lead the requirements gathering, analysis and identifying ways our clients can leverage the Abacus Insights product suite to improve a client’s business outcomes.

🎯 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.