QNXT Implementation Lead – Claims, Provider, Contracts, Product and Benefits

Description:

The Program Lead, QNXT Implementation is accountable for the successful implementation of the Membership, Capitation, Finance, and Correspondence workstreams within the QNXT core platform transformation, including migration from the current IKA platform.

This role leads end-to-end planning, execution, governance, and delivery while coordinating closely with business leaders, product managers and owners, internal subject matter experts, technology teams, system integrators, and external consultants.

The Program Lead ensures deliverables are completed accurately and on schedule, risks and dependencies are actively managed, teams remain aligned and accountable, and the organization is prepared for testing, cutover, go-live, and post-implementation stabilization.

What You Will Do:

• Lead business-side execution for the core administrative platform transformation, serving as the primary point of coordination among business leaders, IT teams, system integrators, consultants, and vendors.
• Serve as the accountable program workstream lead for the QNXT implementation, with end-to-end responsibility for planning, execution, issue resolution, and successful migration from IKA.
• Develop and manage an integrated implementation plan covering business operations, configuration, data, testing, training, organizational readiness, and cutover activities.
• Ensure milestones, deliverables, ownership, dependencies, and success criteria are clearly defined, monitored, and achieved.
• Coordinate alignment across supporting workstreams, including Membership, Claims, Provider Data, Finance, Correspondence, Configuration, Provider Contracts, Benefits, Utilization Management and business rules, and Capitation.
• Partner with future-state designers, internal SMEs, technology teams, and consultants to define workflows, business requirements, operating model changes, and implementation decisions.
• Lead workstream governance, including status reporting, RAID management, decision tracking, escalation management, and communication with leadership and program stakeholders.
• Ensure implementation deliverables are complete, accurate, and traceable, including requirements, process designs, configuration inputs, conversion needs, test scenarios, defect-resolution plans, readiness criteria, and go-live support materials.
• Coach and coordinate cross-functional program managers and SMEs by establishing clear ownership, promoting disciplined execution, removing barriers, and driving accountability.
• Manage day-to-day collaboration with implementation consultants and vendors to ensure scope, deliverables, timelines, and design decisions align with business objectives, operational needs, and enterprise governance standards.
• Lead implementation readiness for testing, mock conversions, cutover, and go-live by confirming operational preparedness and validating defect-remediation and contingency plans.
• Support a stable and controlled transition from legacy operations to the future-state QNXT environment.
• Identify execution risks, workflow gaps, and dependency failures early and implement corrective actions that protect the timeline, quality, processing accuracy, and stakeholder confidence.
• Explore and support the responsible use of AI to improve operations and the member experience.
• Actively support the achievement of SCAN’s vision and goals.
• Perform other duties as assigned.

You Will Be Successful If:

• You can translate strategic goals and future-state designs into clear business requirements, implementation priorities, accountable ownership, and executable plans.
• You effectively align senior leaders, SMEs, operational teams, technology partners, and consultants around decisions, priorities, and timelines.
• You build and maintain integrated workplans, deliverable trackers, RAID logs, decision logs, and governance routines in a complex program environment.
• You coach cross-functional teams, resolve barriers, drive accountability, and elevate performance in fast-paced, ambiguous, and high-stakes situations.
• You identify risks early, evaluate tradeoffs, resolve blockers, and make sound decisions when information is incomplete.
• You balance strategic transformation objectives with day-to-day operational realities.
• You ensure the organization is prepared for testing, defect triage, operational readiness, cutover, go-live, and stabilization.
• You demonstrate strong program leadership, execution discipline, executive communication, stakeholder management, change leadership, and results orientation.
• You maintain productive relationships with consultants and vendors while holding all parties accountable for scope, quality, and delivery.

What You Will Bring:

• A bachelor’s degree in Business, Health Administration, Information Systems, or a related field, or an equivalent combination of education and experience.
• A master’s degree in Business Administration, Public Health, Health Administration, Information Systems, or a related field is preferred.
• At least six years of related experience within a health plan, healthcare organization, or related industry.
• Strong knowledge of healthcare payer operations and the end-to-end processes required to support accurate adjudication, pricing, payment, and issue resolution.
• Experience leading large, cross-functional system implementations or business transformations involving claims, membership, operations, configuration, data, testing, and operational readiness.
• Working knowledge of QNXT or a comparable core administrative platform.
• An understanding of the relationships among claims processing, membership, provider data, benefits, contracts, utilization management and business rules, capitation, finance, and correspondence.
• Experience supporting implementation testing, defect triage, mock conversions, operational readiness, cutover planning, go-live, and post-launch stabilization.
• Strong facilitation, written and verbal communication, influencing, analytical, and problem-solving skills.
• Demonstrated experience with program leadership, strategic planning, risk management, organizational change, vendor management, and cross-functional team development.
• Advanced proficiency with Microsoft Word, Excel, PowerPoint, Outlook, Teams, Access, Visio, and SQL.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical and operations management, enterprise project management, professional services, and software consulting. We help our clients increase operational efficiency by delivering innovative solutions to their most complex business challenges.

Our approach has always been simple: think and act like the customers who need us and deliver what larger organizations cannot. We provide tangible results that add immediate value at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!