Description

JOB SUMMARY

The Clinical Informatics Specialist for the Health Plan promotes the understanding, integration and application of healthcare information technology in support of clinician/provider objectives, the organization's vision, strategic goals and industry best practices. The Clinical Informatics Specialist drives the optimal, efficient and effective use of clinical information systems and technology as it relates to patient care, patient safety, user satisfaction, clinical productivity and quality outcomes. The Clinical Informatics Specialist will serve as a key constituent that bridges the gap between Health Services and Information Technology and Systems.

ESSENTIAL FUNCTIONS OF THE ROLE

• Utilizes knowledge of policies, procedures, and processes to provide help/guidance/feedback for process improvements, user acceptance testing, education, and implementation/upgrade assistance.

• Understands the service line workflows and functions and the impacts from and across information technology. Helps align processes with technological functions and capabilities.

• Demonstrates knowledge of one or more health care regulations and the impact on end user workflows and existing functionality through participation in continuing education, journal clubs, debates or other health informatics helped educational workshops.

• Assists with the investigation, statement of problems, and resolutions of challenges across information systems applicable to clinical services and programs. Able to solve more complex problems extending across single service lines/business units. Frequently seeks discovery from peers and direct supervisor. Follows-up with customers during and after the delivery of services to ensure that their needs have been met.

• Demonstrates ability to work closely with project and program managers to organize tasks, drive actions, deliverables, and activities toward achieving project and problem-solving milestones with minimal supervision. Manages time to meet all milestones and deliverable dates. Escalates issues with task assignment and milestones appropriately. Seeks out opportunities to drive low complexity enhancements or specific activities associated with issues, improvement efforts, and changes between operations or business and information technology.

• Partners with training and management teams to develop and lead clinical communication Assists with discovery and design sessions aimed at preparing clinical teams for workflow and process changes as they incorporate data/technology with functions and services. Develops basic presentation and meeting facilitation skills. Displays a positive attitude in the face of ambiguity and change.

• Serves as a resource to end users for information systems and technology.

• Provides ongoing assistance with clinical applications/systems for upgrades, new releases, enhancements, and implementations. Effectively communicates system changes, workflow process changes, downtime procedures, etc. to all clinicians/ providers.

• Develop Utilization Management (UM), Care Management (CM) and Appeals and Grievances (A&G) reporting from the Electronic Health Record and other clinical/claims data resources.

• Validate data quality for all internal and external UM, CM and A&G reporting including regulatory reporting.

• Document UM, CM and A&G specifications that will translate into the development or update of tools, reports, and system workflow that support solutions to organizational business needs.

• Collaborate and problem solve with other departments, such as Claims, Provider/Network Relations, and Call Center Specialists in the development and revision of data collection, dataflow and exchange, retrieval, analysis, and interpretation to assist in optimizing outcomes, effectiveness and efficiency.

• Facilitate and support clinical champions and robust super-user programs.

• Sets clear self-development expectations. Demonstrates initiative in professional self-development. Initiates partnership with others and spontaneously assists others in the delivery of their work.

KEY SUCCESS FACTORS

• The ideal candidate must have a deep understanding of clinical practice as it pertains to the integration of clinical information systems/technology and impact on end users and other departments.

o Sound knowledge of clinical practice as it pertains to the integration of clinical information systems/technology and impact on end users.

• Two or more years of experience in a clinical environment required.

• Knowledge of clinical practice, common challenges and issues, and compliance of current standards/competencies, regulatory requirements, contractual agreements, and policy/procedure requirements.

• Bachelor's degree in healthcare related field preferred.

o Examples: Licensed/Registered clinician such as nurse, physical therapist, occupational therapist, pharmacy technician, dietitian, respiratory therapist, etc. preferred.

• Two or more years of experience working in informatics role preferred.

• SQL Server Management Studio (SSMS) and other SQL infrastructure and environment knowledge and skills including accessibility, configuration, management, administration, and development skills are preferable.

o SQL query creation, manipulation, and extraction of data based on specific requirements for audits and reports, analyses of datasets, and communication of findings across various non-technical departments are essential activities.

• Excellent communication (verbal and written), social and organizational skills, self-direction, process evaluation and translation, critical-thinking, problem-solving, and analytical skills are essential.

• Ability to effectively utilize resources with fiscal responsibility in planning, implementation, and evaluation.

• Ability to manage and lead activities, projects, and initiatives as they relate to clinical services/programs/operations and information technology and systems.

• Successful completion of health information education and training is preferred.

BENEFITS

Our competitive benefits package includes the following:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification

• EXPERIENCE - 2 Years of Experience