Clinical Business Analyst - Senior

WellCare - Tampa, FL (30+ days ago)3.5


Department: Health Services - Informatics

Reports to: Sr. Manager, Clinical Systems

Location: 8745 Henderson Rd, Tampa, FL 33634

Job Type: Salaried/ Exempt

Drawing on clinical knowledge, this position leads the collaborative effort with various levels of clinical staff and IT staff to clarify needs, prioritize requests, and recommend workflow enhancements to the medical management platform. Responsible for evaluating and documenting clinical processes, including step actions and workflows to construct and enhance the clinical model of care. Provides project guidance and leadership to other Clinical Business Analysts.

Essential Functions:
Functions as a user advocate and consultant to maximize functional use of new platform.
Acts as subject matter expert for assigned work stream units - Intake, UM, CM, DM, Reporting and/or Appeals.
Identifies workflow and process gaps in order to make recommendations and implement change processes, using clinical and systems knowledge.
Guides the documentation process and the gathering of detailed requirements and workflow processes/analysis.
Reviews current workflow and lead recommendations and defines requirements to build processes and forms needed to support the business in the new system.
Recommends and implements software based on best practices.
Analyzes customer needs and identify system and procedural solutions to enhance the clinical practices.
Identifies opportunities to leverage technologies in areas that improve and promote the clinical agenda.
Performs gap analysis and identifies solutions for improvement.
Identifies needed process changes to ensure compliance with the use of technology to optimize care delivery processes and effectively communicate patient care activities. Develops and creates test plans for SIT and UAT. Performs application testing and creates test scripts – SIT/UAT.
Performs UAT Testing and works with IT to resolve issues.
Communicates with Project Leads to obtain sign-off on improved processes.
Ensures updates are tested and applied on a timely basis.
Provides documentation and training as needed.
Insures technology meets Compliance and Regulatory Requirements.
Provides guidance and leadership to other analysts on team.
Performs other duties as assigned.

Candidate Education:
Required A Bachelor's Degree in a related field, preferably health sciences
Required or equivalent work experience 5 years clinical experience with active RN/LPN/MD/DO/ARNP/RT/PharmD license in a managed care setting

Candidate Experience:
Required 7 years of experience in a position that requires participation in and knowledge of Care Management operations and regulations that affect clinical processes and reporting
Required 1 year of experience in clinical systems implementation

Candidate Skills:
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Advanced Ability to work as part of a team
Advanced Ability to work independently
Intermediate Other Ability to work with consultants and vendors in support of project initiatives
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated organizational skills
Intermediate Other Ability to remain calm under pressure
Intermediate Other Ability to work overtime as required

Licenses and Certifications:A license in one of the following is required:
Preferred Licensed Registered Nurse (RN)

Technical Skills:
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Advanced Microsoft PowerPoint
Required Advanced Microsoft Excel
Required Intermediate Microsoft Access
Required Advanced Microsoft Visio