Clinical Operations Configuration Analyst II, SQL

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August 25

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CareSource

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Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• 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. • 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 • Gather and analyze data and help to create business cases for new systems • Perform any other job duties as requested

🎯 Requirements

• 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 • 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 • Knowledge of SQL Server and performing basic querying required • 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 • 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

🏖️ Benefits

• 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.