The Clinical Informatics Specialist plays a crucial role at the intersection of healthcare and information technology. This role will be responsible for bridging the gap between the utilization management staff and information technology. The primary responsibility is to optimize the use of technology and data to enhance workflow efficiency, ensure compliance for both internal and external utilization teams and support clinical decision-making. The role involves analyzing, assisting with the design, implementing, and optimizing health information systems to ensure they meet the clinical and operational needs of the organization.
This is a full-time remote opportunity. There is no expectation of being in the office routinely, however, the selected candidate must be available to travel onsite as needed.
The selected candidate must reside in North Carolina.
Responsibilities & Duties
Workflow Analysis
Analyze existing clinical workflows to identify areas for improvement and optimization by collaborating with UM supervisors, directors and SVP, and clinical trainer
Develops and maintain process documentation to support front line staff
Ensures system configuration accurately reflects workflows in collaboration with IT, compliance and Quality NCQA leadership
Ensure workflows remain compliant with state regulatory and NCQA requirements in collaboration with compliance and Quality NCQA leadership
System Implementation and Integration
Support Medical Management Systems launch, releases and enhancements by assisting in business requirement development in collaboration with IT and Clinical Trainer
Support Medical Management Systems launch, releases and enhancements by assisting in testing
Collaborate with IT system configuration teams to improve system functionality
Data Management
Review, analyze and report Daily Operational and Control Reports from internal UM and delegates to ensure accuracy and operational excellence. Information is submitted on schedule as required to UM Leadership as frequent as daily, monthly and/or quarterly
Identify and mitigate risks associated with the use of clinical informatics systems, including (but not limited to) interoperability of systems and system downtime
Collect, analyze and interpret healthcare data to support decision-making processes to ensure quality performance and improve patient outcomes
Delegation Oversight
Ensure compliance with UM components of delegate SOW activity including but not limited to monthly UM activity monitoring, programs description review, and IRR reporting
Prepare delegate outcome reports for delegation oversight committee
Regulatory Compliance/ Audit Readiness
Ensure the accuracy and integrity of the clinical data systems, while adhering to regulatory requirements (NCQA, EQRO, etc.)
Facilitate appropriate UM readiness team for regulatory bodies above in preparation for internal/external record audits and site audits
Own the documentation of compliance (bookmarking) with standards
Oversight of Monthly State and NCQA Reporting prior to delivering to compliance and/or quality NCQA team
Minimum Requirements
Education & Experience
Required:
Bachelor's degree in nursing and five (5) years of experience in healthcare administration, clinical informatics, or a related field with a valid Registered Nursing license.
Or
A master’s degree in medicine, healthcare informatics, or a related field and five (5) years of experience in healthcare administration, clinical informatics or a related field with a valid NC clinical license.
RN or social work license (LCSW, LCMHC, LPA, or LMFT) is required for this role.
Preferred:
A Master's degree in Healthcare Informatics is preferred.
Certification in Health Informatics (e.g., Certified Health Informatics Systems Professional - CHISP) preferred.
Knowledge, Skills, & Abilities
Clinical experience in a healthcare setting.
Strong presentation, collaboration, and communication skills.
Strong attention to detail, critical thinking, and problem-solving capabilities.
Demonstrated skills in computer software, spreadsheets, databases and modeling programs.
Experience collecting user requirements, translating to system feature enhancements.
Knowledge of State and NCQA regulatory requirements.
Salary Range
81,375.00 to 135,625.00/Anually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long and Short Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave