Director, Enterprise Applications

This is a fully remote position, open to applicants in Maine.

📋 Description

• Guides and integrates the Health Plan Applications (HPA) teams into a cohesive unit with distinct IT and business ownership, clearly defined roles, and a sustainable operational framework for core system configuration.

• Ensures high-quality, timely system configuration and maintenance of essential health plan systems, such as QNXT, care management, and enrollment platforms.

• Supervises, develops, and sustains documentation for claims and benefit configuration procedures with the necessary controls, reporting, and quality assurance.

• Creates comprehensive testing protocols and assists with regular audits and quality assessments to guarantee configuration precision, data integrity, and system performance.

• Leads the Application Development team in the design, construction, and support of custom applications and system integrations utilizing SDLC, DevOps, and secure development standards.

• Provides direction for the Enterprise Salesforce/CRM platform, encompassing platform ownership, administration, release management, and application support.

• Collaborates with Enterprise Architecture to ensure application solutions align with enterprise standards, technology roadmaps, integration, and data strategies.

• Establishes work intake mechanisms and tools to manage ticket inventory, prioritize backlogs, and evaluate work types.

• Offers vendor oversight to enhance system processing and explore new vendor opportunities, including RFI/RFP processes.

• Works closely with business, Operations, Data & Analytics, and IT teams to ensure system and operational readiness for fixes, configurations, and project implementations.

• Coordinates with infrastructure and integration teams regarding system upgrades, enhancements, integration updates, and file loads.

• Manages the Enterprise Applications budget, staffing plans, and vendor expenditures; monitors performance against key metrics and service levels.

• Exemplifies the organization’s mission, vision, and core values.

⛳️ Requirements

• A Bachelor's degree is required.

• Over 10 years of experience in health plan or healthcare information technology, with at least 5 years in leadership roles involving application, configuration, or development teams is required.

• Experience in managing vendor-based core system applications is required.

• Proven track record in leading organizational change and transforming team operational models is required.

• Proficient in test plan development, strategy, and execution is required.

• In accordance with MPHC’s Department of Defense contract, all candidates for this position must verify their U.S. citizenship and complete the necessary employment eligibility verification upon hire.

• A Master's degree in Business Administration, Information Systems, or a related advanced field is strongly preferred.

• Certifications in Project Management (PMP), Agile/SAFe, ITIL, or Salesforce are preferred.

• Strong preference for experience with Cognizant (TriZetto) QNXT configuration, administration, or implementation.

• Preferred experience leading application development teams (custom development, integrations, SDLC).

• Familiarity with Salesforce or other CRM platforms is preferred.

• Experience supporting Medicare Advantage and/or TRICARE lines of business is preferred.

• Knowledge of CMS interoperability requirements (e.g., CMS-0057-F) and healthcare data standards (HL7 FHIR, X12 EDI) is preferred.

• Understanding of Agile delivery practices and IT service management (ITSM) is preferred.

• Proficiency with work management and ticketing tools (e.g., Jira, ServiceNow, Azure DevOps) is preferred.

• Knowledge of reimbursement agreements and claims and billing practices that affect cost and utilization data.

• Understanding of industry standards for claims and enrollment configuration, reporting, and analysis.

• Familiarity with 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.

• Excellent skills in workflow and inventory management.

• Strong interpersonal, communication, operational, team-building, and quality improvement skills are essential.

• Demonstrated leadership, coaching, and change management capabilities.

• Ability to effectively communicate with executive leadership and translate business needs into technological solutions.

• Demonstrates an understanding of and alignment with Martin’s Point Values.

• Fosters 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 evaluate performance against metrics.

• In-depth technical knowledge and willingness to learn new technologies; familiarity with the Software Development Life Cycle (SDLC).

• Capable of managing, organizing, and prioritizing workload in a timely and accurate manner.

• Ability to handle multiple competing demands and work independently.

• Strong critical thinking skills to identify root causes and implement both short- and long-term sustainable solutions.

• This position is not eligible for immigration sponsorship.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Retirement savings with employer contributions

• Paid time off

• Volunteer time off

• Pie day

• Other employee benefits

• Additional compensation, such as incentive or commission-based programs, where applicable and subject to the terms of the applicable plan