Sr. Technical Program Consultant

Position Summary:

Serves as a key operational and technical leader, partnering with business and clinical stakeholders to drive the execution of strategic UM projects, daily operations, and vendor management for Health and Medical Management systems, including MHK and Command Digital (SCI).

This role is responsible for the end-to-end lifecycle of HMM systems, from development and configuration to implementation and optimization. The Sr. Technical Program Consultant will lead and facilitate complex system development activities, including gathering and documenting business requirements, defining workflows, and reviewing system specifications. As the primary contact for senior leaders in Utilization Management (UM) and other modules / business areas as needed. The candidate will translate business needs into technical solutions, analyzing upstream and downstream impacts to guide system enhancements.

This role includes directing the user acceptance testing process, managing implementation activities for Tier 1 applications like MHK, and proactively identifying and mitigating business risks to ensure project deliverables are met. The Sr. Technical Program Consultant will also oversee the complete operational management of the MHK system, leading release management, troubleshooting system errors, and driving continuous optimization to support the strategic goals of the Health Management department.

Key Results / Responsibilities:

• Lead large-scale, cross-functional programs and projects from concept to completion, ensuring alignment with the strategic direction of Health and Medical Management.
• Perform senior-level strategic, qualitative, and quantitative analysis to resolve complex issues.
• Leverage data and analytics to drive operational effectiveness, process improvement, and cost-management initiatives.
• Generate and recommend innovative solutions to meet market demands, mitigate trends, and achieve quality targets.
• Utilize deep expertise in business processes, data flows, and system integrations to proactively identify and act on opportunities for improvement.
• Act as a technical leader and direct Health and Medical Management and Enterprise IT teams in the management and implementation of new initiatives for Tier 1 applications (MHK)
• Lead complex configuration across multiple modules, including Utilization Management, and other modules as needed include Prior Authorization file & Auto Authorization rules.
• Ensure the design and integration of proposed configurations, processes, and workflows support business growth through the effective use of technology.
• Apply hands-on data modeling, table design, and technical skills to help operational areas optimize their workflows and processes.
• Oversee the end-to-end performance and stability of HMM applications, collaborating with vendors and internal teams.
• Serve as the primary UM business release manager for key vendor relationships (e.g., MHK, SCI), ensuring vendors meet all financial, operational, and clinical performance goals.
• Act as a key consultative partner to senior business operational and clinical leaders, understanding their objectives and providing expert recommendations.
• Lead business testing for all UM projects; partner with the ET QA lead and HMM project manager to determine all testing deadlines and deliverables.
• Manage the monthly release cycle and ensure vendor delivery timelines are met.
• Contribute to staff development by serving as a role model, mentor, and lead for technical program consultants.

Key Functions:

• Configuration of highest complexity Core Application and Portal requests including System Tables, System Variables, Letters, Assessments, Notes and Drop Downs across multiple modules.
• Own and execute complex configuration management of Prior Authorization and Auto-Authorization tables within the Tier 1 application (MHK), ensuring system logic precisely reflects current clinical policies, payer contracts, and regulatory mandates. Testing of changes / enhancements
• Responsible for execution of the monthly release schedule to ensure deadlines are met and high-quality product is delivered.
• Root cause analysis and identifies preventative actions including defect resolution.
• Evaluates Operational Impact of System Changes
• Incidence investigation and resolution in JIRA application
• Forecasting of Configuration work across multiple modules
• Monitor Systems and Vendor Performance
• Determine level of effort requested configuration tasks and prioritize meeting due dates in timely manner.
• Updating and maintaining the application workbook documentation

EDUCATION:

Bachelor's degree in Business or IT.

MBA, MIS, MS, or MPH preferred.

SKILLS, KNOWLEDGE, AND EXPERIENCE:

• Minimum 7 years' experience in System Implementation
• Broad knowledge of Agile and Waterfall methodologies.
• Minimum 7 years' experience in a healthcare environment required.
• Minimum 7 years' experience in project management required.
• Operations experience in a Medical Management Operations preferred.
• Demonstrated experience in preparing program specifications as well as developing and executing test plans required.
• Knowledge of medical management functions and processes.
• Strong technical and analytical skill sets.
• Demonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and strong negotiation skills.
• Previous experience of managing in an operations environment include managing staff, developing workflows, implementing process improvements and cost savings initiatives.
• Proven excellent interpersonal, verbal, and written communication skills.
• Previous experience in development and implementation of medical management systems.
• Advanced project management skills, and ability to meet aggressive deadlines.
• Strong presentation skills and ability to present and build consensus with all levels of management.
• Strong working knowledge of BCBS products & systems
• Claims and Utilization Management processing knowledge preferred.

BEHAVIORAL SUCCESS FACTORS:

• Team player able to work in a fast-paced environment under tight deadlines.
• Strong organizational abilities to manage multiple priorities and meet strict deadlines.
• Ability to establish and maintain effective communications between individuals and teams.
• Ability to build, motivate and develop an effective team.
• Strong conflict resolution skills.
• Demonstrated CQI focus.
• Ability to establish short team action plans for department and leads others to achieve objectives.
• Results oriented.

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

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