ikaSystems is a leading provider of cloud computing solutions for the healthcare payer market. Our solutions are revolutionizing the way that healthcare payers do business, supporting commercial, Medicare and Medicaid lines of business. ikaEnterprise, the company’s product suite, automates all key processes in the payer business cycle — from marketing and sales through claims administration and customer service to care and quality management and business intelligence — all on a single integrated platform. We are experiencing explosive growth and have numerous openings in various areas. At ikaSystems, we have an unparalleled commitment to excellence. We have a fast-paced work environment that rewards collaboration, innovation and an entrepreneurial spirit. If you’re looking for a place where your hard work can make a difference, please contact us.
ikaSystems is seeking a Medical Management Subject Matter expert to assist with product development in the area of Utilization Management, Case Management, Disease Management, and Clinical Appeals and Denials supporting Commercial, Medicare, & Medicaid lines of business.
Assist with product improvement by bringing market insights from clients into the product cycle
Provide sales support by creating, customizing and conducting product demonstrations to existing and prospective clients in the healthcare industry
Conduct product demonstrations both in person and/or using web tools such as WebEx and Go To Meeting
RN degree with minimum of 3 years of Payer experience as a utilization management nurse, precertification nurse, clinical appeals specialist, or case manager
Minimum 3 years experience in demonstrating healthcare solutions
Strong proficiency with all aspects of Utilization Management and Clinical Appeals supporting Medicare, Medicaid, and Commercial lines of business
Solid knowledge of NCQA, URAC, & CMS regulatory requirements pertaining to utilization/case management
Strong proficiency in translating customer requirements into engaging product demonstrations
Experience in meeting with customers, either telephonically or in person to identify business goals
Proficient in delivering product demonstrations via Web Tools (Web Ex, Go To Meeting)
Excellent attention to detail in completing follow up action items following product demonstrations
Strong knowledge of the healthcare/managed care industry including commercial health plans, Medicare and Medicaid; medical management work flows, prior case/utilization management program development desired
Experience in program implementations within healthcare industry preferred
Able to prioritize and manage time and resources profitably
Flexibility and ability to adjust to changing priorities and timelines
Exceptional oral, written and interpersonal skills including excellent customer service skills
Motivated and proactive in learning ikaSystems’ solutions to advance own expertise and value
Advanced knowledge of MS Office tools, especially PowerPoint
An average of 40% travel may be required
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender,national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
ikaSystems Corporation - 18 months ago