Clinical Care Analyst
Description
Company Background
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary:
The Clinical Care Analyst plays a pivotal role in our Transition of Care program and reducing necessary utilization in our high priority members at Healthmap Solutions. The role is accountable for developing, implementing, and evaluating comprehensive transition care interventions and opportunities to reduce cost of care for our high priority members. This position partners with our regional care navigation model to positively impact the clinical outcomes of the Kidney Health management population.
Responsibilities:
- Analyze data and reports to identify Healthmap Solutions members that would benefit from care navigation support to reduce inappropriate utilization patterns to improve member health outcomes and reduce cost of care
- Document clinical and, if appropriate, Social Determinants of Health (SDoH), summary of the high-cost and/or high-utilization
- Develop and provide structured action steps for the Clinical Community Liaison, Care Navigators, and Quality Practice Advisors, etc. by utilizing critical thinking skills, clinical assessment skills and acquired knowledge
- Understand Clinical Review such as medical necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Records Reviews
- Working knowledge of cost of care and impact of readmissions
- Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- Active participant in evaluating the High-cost/High-utilizer and Transition of Care strategies
- Document in Electronic Medical Records (EMR) and various technology platforms with accuracy and high-level proficiency to ensure analytics cover components needed for required responsibilities
- Ensure timely and successful delivery of reports
- Perform other duties as assigned
Requirements:
- Bachelor’s degree in nursing required
- Active, unrestricted RN license required; compact and/or multi-licensed preferred
- 5 years of progressive experience in healthcare services, clinical operations, quality, or care management
- 3 + years of clinical experience within any healthcare setting {Acute Care, Outpatient, etc.}
- Experience with of cost of care initiatives that decrease admissions and readmissions
- Certified Case Management (CCM) preferred
- Able to identify variances surrounding HCPCs, CPTs, ICD-10 preferred
- Experience with Medicare and Medicaid preferred
- Residence in assigned state
Skills:
- Excellent verbal, written, listening and presentation skills
- Ability to show compassion and empathy for patients
- Demonstrated interpersonal relationship skills that drive collaboration toward organizational goals
- Ability to multitask, prioritize, and create solutions in a fast-paced environment
- Strong critical thinking and analytical skills
- Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Travel:
Limited Travel, scheduled per needs of the business
#LI-REMOTE
Americans with Disability Specifications
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.