Information Technology Analyst - Unclassified

The Information Technology Analysts working position title is the Plan Certification Manager. The Plan Certification Manager performs work under the direction of the Information Systems Manager and is responsible for coordinating and overseeing plan certification operations for the Nevada Health Insurance Exchange. The position will perform professional, analytical and programmatic work related to Qualified Health and Dental Plan (QHP/QDP) certification, regulatory compliance, operational process review, and stakeholder coordination. The Plan Certification Manager analyzes business processes, reviews Federal and State laws, regulations, CMS guidance, and agency policies to evaluate impacts to plan certification operations and Exchange programs. The position coordinates activities with internal work groups, sister state agencies, insurance carriers, and external vendors to support certification, recertification, oversight, and operational improvements related to Qualified Health and Dental Plans offered through the Nevada Health Link enrollment platform. Additional responsibilities include supporting implementation activities related to plan certification systems and processes, and developing and updating policies, issuer agreements, user manuals, operational procedures, and guidance materials related to plan certification requirements and operations.

Three years of professional or paraprofessional experience in the research, development, evaluation or revision of programs, organizations, methods or procedures, or administration of policies and procedures for a program or functional area; OR an equivalent combination of education and experience on a year-for-year basis.

Preferred Qualifications:

• Experience in insurance administration, leadership, project management, quality assurance and test evaluation/reporting is desired but not required.

• Bachelor's degree from an accredited college or university in public or business administration, finance, social sciences, mathematics or related field and one year of professional or paraprofessional experience in the research, development, evaluation or revision of programs, organizations, methods or procedures, or administration of policies and procedures for a program or functional area

The Plan Cert Manager carries out all plan management activities, including but not limited to the certification of Qualified Health and Dental Plans (QHPs/QDPs), monitoring and oversight of QHPs, issuer account management and recertification and decertification of insurance carriers. These functions are managed closely with the Division of Insurance, the regulating agency for health insurance.

• Review of State and Federal guidance to ensure QHPs and QDPs are in compliance with the Affordable Care Act
• Conduct advanced analytical and investigative reviews related to plan certification operations, issuer submissions, plan data, and operational workflows to ensure compliance with Federal and State requirements
• Work with key internal and external stakeholders in the development, analysis, and continuous improvement of plan certification processes, operational procedures, and program requirements
• Maintain familiarity with CMS QHP templates and review tools and run review tools as needed
• Develop and update Nevada-specific QHP/QDP templates and instructions
• Consults with and provides strategic advice to the Policy, Compliance, Operations, and Executive Management team
• Assist with QHP template upload into the Plan Management module as needed
• Assist the NV Health Authority/Division of Consumer Health Services leadership, external stakeholders and Exchange staff with data inquiries regarding plan design, and utilization to inform requests for information, public use files, and FOIA requests.
• Serve as a Subject Matter Expert regarding plan certification standards. This includes Federal and State requirements, CMS guidance, issuer data, plan design and systems supporting plan certification activities, including System for Electronic Rate and Form Filing (SERFF) and the Plan Management module.
• Analyze proposed legislation, BDRs, Federal guidance, and regulatory changes impacting Exchange operations, plan certification requirements, and Nevada Revised Statutes; evaluate operational and policy impacts and provide recommendations to leadership regarding implementation or program response.
• Conduct advanced analytical, investigative, and operational reviews of plan certification processes, workflows, system functionality, and program operations; recommend and assist in implementing programmatic enhancements, revised procedures, and operational improvements to increase efficiency, effectiveness, and regulatory compliance.
• Monitor and evaluate program performance through certification timelines, operational accuracy, compliance requirements, stakeholder responsiveness, and process improvement efforts to support effective program operations.
• Coordinate with stakeholders and the Exchanges technology vendor regarding system functionality, implementation activities, testing efforts, business requirements, user needs, and future release planning related to the plan certification process.
• Develop and deliver presentations to internal and external groups regarding timeline, policy changes, data collection, analysis and current and future requirements
• Serve as point of contact for carriers, vendors and outside state agencies regarding plan certification requirements and processes
• Independently organize, plan, implement, and oversee multiple concurrent plan certification initiatives, compliance deadlines, stakeholder deliverables, operational priorities, and system-related activities in support of Exchange program objectives.
• Assist with basic troubleshooting of plan management systems and user access issues, escalating to IT/Ops Manager and vendor as needed
• Assist with tracking and documenting system issues, enhancements, and requests using ticketing systems (e.g., Jira or similar)
• Maintain and develop documentation for system processes, user guides, operational manuals, standard operating procedures, and training materials related to plan certification tools and workflows
• Conduct research, data analysis, management studies, and operational assessments related to plan certification operations, issuer participation, system performance, and program effectiveness; identify trends, define operational issues, develop practical solutions, and prepare reports, recommendations, and briefing materials for executive leadership, internal stakeholders, and external partners.

Working knowledge of: techniques of statistical analysis including data collection, evaluation, analysis, financial statements and manipulation; accounting, auditing, financial reporting and/or research/statistical methods and techniques.

General knowledge of: legislative proceedings and processes; government agencies, resources and functions sufficient to locate and obtain needed information and/or resources, accepted practices and methods used in designing program reviews and audits.

Ability to: read, interpret, and apply complex rules and regulations for various funding sources; read and interpret technical reports, governmental publications and federal directives; write comprehensive reports, recommendations and legislative proposals using correct English grammar, spelling, vocabulary and punctuation. Skill in: developing computer generated reports; and organizing, developing and making oral presentations; advanced level financial analysis, planning, preparation and administration; advanced mathematical and statistical computation; designing analytical research studies; identifying research needs and problems; coordinating and implementing diverse work plans; advanced research and analysis techniques.

Recruiter Contact Information: Victoria Sheehan - ...