Business Consultant in NORFOLK, Virginia

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles or a 1-hour commute each way of one of our Elevance Health PulsePoint locations.

Schedule: Monday-Friday 8am-5pm EST . 4 days virtual , 1 day at the designated pulse point.

Responsible for translating moderately complex and varied business needs into business requirements with technical impacts. Possesses full technical knowledge of most phases of project life cycles, including systems and business impacts, and is able to consider the business implications of the application of technology to current and future business environments.

PRIMARY DUTIES:

• Lead discovery and requirements refinement sessions to uncover customers’ business, functional requirements and synthesize requirements to create clear and comprehensive high level and detail business requirements with acceptance criteria.

• Analyzes complex end user needs to determine optimal means of meeting those needs.

• Determines specific business application software requirements to address complex business needs.

• Prioritize multiple efforts including but not limited to mandates, implementations, and operational support across multiple lines of business for both pharmacy and medical injectable (specialty pharmacy) benefits.

• Develops requirement traceability metrics enabling traceability to both the project plan and test plan.

• Partner with cross functional teams – business, programming, and testing staff to ensure requirements will be incorporated into system design and testing.

• Utilize Blueprint requirements management tool to document business requirements, obtain stakeholder signoff, and manage requirements through project lifecycle end to end processes ensuring smooth transition and requirements traceability to technical partners.

• Acts as a resource to users of the software to address questions/issues for multiple prior authorization platforms.

• Acts as a resource supporting BPL formulary crosswalk mapping for GRS clients and Medicare Product Launch (MPL).

• Provide direction and guidance to team members and serves as an expert for Legal/Executive/Regulatory Decision Special Handling Instructions requirements.

• Provide direction and guidance to team members and serves as an expert of prior authorization requirements including workflows, letters, timers, reporting, and electronic PA processes.

REQUIREMENTS:

• Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

• Knowledge of systems capabilities and business operations is strongly preferred.

• Knowledge of Service Now and Blueprint Business Capability Model (BCM) integration

• Knowledge of PBM Domain and Capability Architecture supporting BCM

• Ability to write Capability Incremental Statements (CISs) supporting BCM

• Requires minimum of 5 years of pharmacy Experience

PREFERRED QUALIFICATIONS:

• PBM and pharmacy knowledge preferred.

• Knowledge of requirement management tool Blueprint strongly preferred.

• Prior authorization experience strongly preferred.

• Experience with multiple membership demographics including Medicaid, Medicare, GRS, Commercial, and MEWA strongly preferred.

• Experience with retail pharmacy and medical injectable (specialty pharmacy) benefits and nuances strongly preferred.

• Experience working with mandates and regulatory business units strongly preferred.

• Knowledge of Agile/Safe practices preferred.

• Knowledge of systems capabilities and business operations strongly preferred.