Sr. Clinical Operations Analyst, RN - Community Health Choice
Harris Health System
Location: Houston, Texas
Type: Full Time
Internal Number: 162455
JOB SUMMARY: The Sr. Clinical Operations Analyst supports departmental clinical activities related to reviewing clinical information and claims data required for decision making by the Senior Leadership Team. This position works closely with the clinical operations team on initiatives to include working with leadership and analytics to respond and submit regulatory reporting requests.' Also working with IT and Medical Affairs Leadership to assist with system implementations and testing; and projects to monitor performance, validate outcomes, identify improvement opportunities that can be leveraged strategically, clinically and operationally. The analyst reviews aggregated clinical data for early issue detection, trend analysis and process analysis to identify improvement opportunities to ensure appropriate fiduciary control, cost containment and operational performance efficiency; collaborates with cross-functional departments in defining and selecting appropriate metrics, methods and tools, to evaluate key performance metrics in the determination of meeting contractual expectations and standards; and provides written documentation to management to support the development of clinical programs, processes and/or tools to ensure successful outcomes.
1. Education/Specialized Training/Licensure: Bachelor's or Master's Degree in Nursing, One of the following preferred: Certified Case Manager, or Certified Managed Care Nurse or any other healthcare or management certification. Current unrestricted Texas RN license 2. Work Experience (Years and Area): 5 years of managed care, including 3 years? experience working within applicable state, federal, and third-party regulations required. Medicaid/Medicare population experience with increasing responsibility and 2 years of working with health-related data to analyze trends, identify utilization patterns and support decision making required. 3. Software Operated: Microsoft Office (Word, Excel, Outlook), InterQual
1. Communication Skills: Above Average Verbal (Heavy Public Contact) Exceptional Verbal (e.g., Public Speaking) Languages: Bilingual (English/Spanish) preferred Writing /Composing: Correspondence / Reports
2. Other Skills: Analytical, Medical Terminology, Research, Statistical
Master's Degree Major: Nursing, Business, Healthcare Administration or related field preferred.
4. Work Schedule: Flexible
5. Other Requirements: Previous experience in health care service setting; Experience in utilization management/case management standards Experience in clinical criteria reviews working with InterQual, TMPPM and other medical review guidelines required. Familiarity with clinical and healthcare administrative data Experience creating complex analyses and developing reports Ability to rapidly learn new technology, concepts, models and methods and effectively employ in projects and processes Interpersonal skills, excellent written and verbal communication Ability to work effectively both independently and in cross functional teams Broad business understanding of clinical development processes Proven attention to detail and ability to think creatively and work collaboratively in a rapidly changing environment
POTENTIAL OCCUPATIONAL HEALTH EXPOSURES: Required to enter facilities where patient care is provided
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.