Saltar al contenido
Introducción

We are seeking an experienced Industry Consultant in Healthcare Payer domain with SME knowledge in Care Management and Utilization Management. This role will play a critical part in managing Care Radius application for a healthcare client and will directly support the successful execution of multiple complex initiatives planned for this application.

A career in IBM Consulting is built on long-term client relationships and close collaboration worldwide. You’ll work with leading companies across industries, helping them shape their hybrid cloud and AI journeys. With support from our strategic partners, robust IBM technology, and Red Hat, you’ll have the tools to drive meaningful change and accelerate client impact. At IBM Consulting, curiosity fuels success. You’ll be encouraged to challenge the norm, explore new ideas, and create innovative solutions that deliver real results. Our culture of growth and empathy focuses on your long-term career development while valuing your unique skills and experiences.

In this role, you'll work in one of our IBM Consulting Client Innovation Centers (Delivery Centers), where we deliver deep technical and industry expertise to a wide range of public and private sector clients around the world. Our delivery centers offer our clients locally based skills and technical expertise to drive innovation and adoption of new technology.

Su función y responsabilidades

•  Serve as a domain SME for the Care Radius application, supporting end-to-end development, enhancements, and issue resolution.
•  Collaborate closely with business stakeholders across Utilization Management, Care Management, and Provider Operations to translate requirements into functional and technical solutions.
•  Drive improvements across workflows related to Authorizations, Referrals, Appeals, Grievances, Case Management, and Enrollment.
•  Provide guidance on JCS and JEDI rules engine configurations to ensure accurate and efficient processing.
•  Analyze claims, membership, and provider data flows to support system optimization and defect resolution.
•  Partner with cross-functional teams including development, QA, architecture, and operations to deliver high-quality product releases.
•  Contribute to roadmap planning for upcoming Care Radius initiatives by bringing deep industry insights and application knowledge.

Educación requerida
Licenciatura
Educación preferida
Maestría
Experiencia profesional y técnica requerida

•  7 to 10 years of experience in the U.S. healthcare payer industry, with strong domain knowledge across Commercial, Medicaid, Medicare, and Braven Health lines of business.
•  Extensive hands-on experience with Care Radius, including workflows for Utilization Management and Care Management.
•  SME-level understanding of JCS and JEDI rules engines.
•  Proven ability to work with business and operational teams on authorizations, appeals, grievances, referrals, and enrollment processes.
•  Strong analytical skills with exposure to claims, membership, and provider data flows.
•  Technical hands-on experience on TCL and Javascript with the ability to collaborate effectively with technical development teams.

Experiencia técnica y profesional preferida

•  Basic technical knowledge of Java and SQL
•  Proficient in CICD development and deployments using Jenkins and Bitbucket
•  Experience in contributing to complex, multi-phase platform enhancement programs.
•  Ability to mentor teams and act as a bridge between business SMEs and technical groups.

Acerca de la Unidad de Negocios

IBM Consulting es la unidad de negocio encargada de la consultoría y servicios profesionales globales de IBM, con capacidades líderes en el mercado en transformación empresarial y tecnológica. Con una gran experiencia en diversas industrias, ofreciendo servicios de estrategia, experiencia, tecnología y operaciones a muchas de las empresas más innovadoras y valiosas del mundo. IBMers en Cosnulting se enfocan en acelerar los negocios de nuestros clientes a través del poder de la colaboración. Creemos en el poder de la tecnología utilizada de manera responsable para ayudar a las personas, los socios y el planeta.

SU VIDA @ IBM

In a world where technology never stands still, we understand that, dedication to our clients success, innovation that matters, and trust and personal responsibility in all our relationships, lives in what we do as IBMers as we strive to be the catalyst that makes the world work better.

Being an IBMer means you’ll be able to learn and develop yourself and your career, you’ll be encouraged to be courageous and experiment everyday, all whilst having continuous trust and support in an environment where everyone can thrive whatever their personal or professional background.

 

Our IBMers are growth minded, always staying curious, open to feedback and learning new information and skills to constantly transform themselves and our company. They are trusted to provide on-going feedback to help other IBMers grow, as well as collaborate with colleagues keeping in mind a team focused approach to include different perspectives to drive exceptional outcomes for our customers. The courage our IBMers have to make critical decisions everyday is essential to IBM becoming the catalyst for progress, always embracing challenges with resources they have to hand, a can-do attitude and always striving for an outcome focused approach within everything that they do.

 

Are you ready to be an IBMer?

Acerca de IBM

IBM’s greatest invention is the IBMer. We believe that through the application of intelligence, reason and science, we can improve business, society and the human condition, bringing the power of an open hybrid cloud and AI strategy to life for our clients and partners around the world.

 

Restlessly reinventing since 1911, we are not only one of the largest corporate organizations in the world, we’re also one of the biggest technology and consulting employers, with many of the Fortune 500 companies relying on the IBM Cloud to run their business. 

 

At IBM, we pride ourselves on being an early adopter of artificial intelligence, quantum computing and blockchain. Now it’s time for you to join us on our journey to being a responsible technology innovator and a force for good in the world.

IBM is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, neurodivergence, age, or other characteristics protected by the applicable law. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.

Otros detalles relevantes del empleo

When applying to jobs of your interest, we recommend that you do so for those that match your experience and expertise. Our recruiters advise that you apply to not more than 3 roles in a year for the best candidate experience. For additional information about location requirements, please discuss with the recruiter following submission of your application.