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