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Clinical Business Analyst

Company: Wellcare
Location: Tampa
Posted on: April 19, 2019

Job Description:

Works collaboratively with various levels of clinical staff and Information Systems staff to clarify needs, prioritize requests, and recommend workflow enhancements. Responsible for evaluating and documenting clinical processes, including step actions and workflows to construct and enhance the clinical model of care. REPORTS TO: MANAGER, OF CLINICAL SYSTEMS DEPARTMENT: HEALTH SERVICES INFORMATICS POSITION LOCATION: TAMPA, FL 33634

Essential Functions:

  • Serves as a clinical resource for an assigned work stream unit - Intake, UM, CM, DM, Reporting or Appeals.
  • Assists in the documentation and gathering of detailed requirements and workflow processes and 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.
  • Identifies needed process changes to ensure compliance with the use of technology to optimize care delivery processes and effectively communicate patient care activities.
  • Performs application testing and creates test scripts - SIT/UAT.
  • Develops and creates test plans for SIT and UAT.
  • Performs UAT Testing.
  • Works with IT to resolve update issues.
  • Communicates with internal partners to obtain sign-offs.
  • Ensures updates are tested and applied on a timely basis.
  • Provides documentation and training as needed.
  • Insures technology meets Compliance and Regulatory Requirements.
  • Performs other duties as assigned. Candidate Education:
    • Bachelor's Degree in a related field, preferably health sciences or equivalent work experience which is 5 years of relevant work experience required without a Bachelors degree is required Candidate Experience:
      • 3 years of experience in a managed care organization using clinical skills is required
      • System implementation experience is required
      • 1 year of experience in Utilization Management and/or Care Management is preferred Candidate Skills:
        • Demonstrated written communication skills
        • Demonstrated interpersonal/verbal communication skills
        • Ability to effectively present information and respond to questions from peers and management
        • Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
        • Ability to work as part of a team
        • Ability to work independently
        • Ability to work in a fast paced environment with changing priorities
        • Demonstrated organizational skills
        • Ability to remain calm under pressure
        • Ability to work overtime as required Licenses and Certifications:
          A license in one of the following is required:
          • LPN or RN is required Technical Skills:
            • Microsoft Outlook is required
            • Microsoft Word is required
            • Microsoft PowerPoint is required
            • Microsoft Excel is required
            • Microsoft Access is required
            • Microsoft Visio is required About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare, Tampa , Clinical Business Analyst, Professions , Tampa, Florida

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