Clinical Operations Configuration Analyst II - GuidingCare/SQL

Job Summary:

The Clinical Operations Configuration Analyst II is responsible to lead define system requirements associated with Care Coordination, Utilization Management and Grievance & Appeals systems requirements definition, documentation, design, testing, training, and implementation support using appropriate templates or analysis tools.

Essential Functions:

• Identify, manage, and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps, root cause analysis and provide end user support. Share & discuss answers identified within the department or by other departments, utilizing Vendor and/or IT for research correction and the development of enterprise-wide solutions including the capabilities for growth.
• Planning/ Maintaining and Environment Strategy /Implementing new software releases, patches, fix, etc. including testing and training from Vendor.
• Maintain understanding & document requirements for all accreditation and regulatory requirements related to the Clinical Operations functions and to ensure the system or process & procedures are available to support the accreditation & regulatory needs.
• Serve as liaison between IT and business areas to research requirements for projects, meet with decision makers to translate IT specifications and define business requirements and system goals.
• Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems
• Conduct preliminary studies to define needs and determine feasibility of system design working with Vendor and IT Teams
• Lead requirements review for core Clinical functions, CM, UM & G&A, as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all Clinical Function changes to the designs and for the core business system and related processes.
• Audit configuration to ensure accuracy and tight internal controls to minimize fraud waste, and abuse.
• Confer with other subject-matter experts and document cross-organizational requirements
• Understand and relate functional requirements to application or infrastructure requirements
• Demonstrate effective translation skills to identify, document and communicate business requirements in technical terms and technical requirements in business terms
• Meet with decision makers, business partners, and end users to define business, financial, and operations requirements and systems goals
• Lead design sessions to prototype solutions to enhance business processes, operations, and information flow
• Review and analyze the effectiveness and efficiency of existing systems and develop strategies to improve or further leverage these systems
• Perform cost-benefit and return on investment analyses for proposed systems to aid management in making implementation decisions, this at time may require preliminary studies such a Proof of Concept to determine feasibility. Gather and analyze data and help to create business cases for new systems
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree in Business Administration, Management Information Systems (MIS), Computer Science, or equivalent work experience in a managed care, business setting, or clinical environment is required
• Three (3) years or more of experience in managed care is preferred; ideally in the departments we support: CM, UM, G&A.
• Minimum of two (2) years configuration experience is required
• Experience with Guiding Care, MCG CareWebQI is also preferred
• Large to medium scale project configuration implementation work is required
• Facets experience is preferred

Competencies, Knowledge and Skills:

• Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets
• Proven understanding of database relationships required
• Experience with Agile and TFS is preferred.
• JSON/XML experience is preferred
• Solid troubleshooting and problem-solving capabilities
• Knowledge of SQL Server and performing basic querying required
• Keep current on technologies through self-directed learning
• Ability to document scope, requirements and functional specifications in a clear and concise manner from foundational document
• Knowledge of Medicaid/Medicare/Healthcare Exchange is preferred
• Ability to manage the requirements throughout the software development life cycle with appropriate tracking to business needs
• Excellent oral and written communication skills
• Ability to manage time effectively
• Effective management and leadership skills
• Effective organization and prioritization skills
• Effective facilitation and interpersonal skills
• Effective relationship management skills
• Advanced level critical thinking skills
• Demonstrated systemic thinking skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.