This Northeast based health plan is an NCQA-accredited managed care organization serving 240,000 members who have access to a provider network of more than 4,300 primary care practitioners, over 13,400 specialists, and 70 (teaching, community, and specialty) hospitals. Products include Medicaid and fully insured commercial plans.
This client had recently completed the implementation of a new core administrative system, replacing all functions except for clinical and quality management. Upon completion of the implementation, the IT leadership team determined that a review of their current staff and structure of the applications support and project management department was required to ensure success for the organization. Ninestone was requested to provide interim IT management as the Director of Configuration and Business Analysis during this time until the department had stabilized post deployment.
Technologies leveraged during this engagement included the full scope of health plan solutions, from billing and eligibility through authorizations, claims and all financial functions. In addition, the EDI and reporting solutions were involved. The department’s job descriptions, interactions with other internal and external stakeholders, communication tools and business applications were reviewed and improved upon.
We created a model for support of the new system within IT for configuration and business analysis and PM functions. Ninestone created a departmental structure and job descriptions in support of the new operating model. We also provided support for vendor management while working with staff to transition to internal management and support.
As a result of our work:
- The department structure and all applicable job descriptions were created in support of the roles required by the new system.
- Performance reviews were conducted and provided to existing staff.
- Vendor management was a new area to the staff and Ninestone had some basic reporting and tracking put in place to manage the vendor work, bug fixes and upcoming upgrades. For transition, one of the manager’s was tasked with working with Ninestone Interim Director to continue the process for vendor management. Over time this manager was promoted to the newly created Director position.
- IT staff engagement and internal satisfaction with the configuration/business analysis team experienced dramatic improvement.