Clinical Care Analyst - Remote

Overview

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.

In Short

• Analyze data and reports to identify members for care navigation support
• Document clinical and Social Determinants of Health summaries
• Develop structured action steps for the Clinical Community Liaison and Care Navigators
• Understand Clinical Review processes
• Knowledge of cost of care and readmissions impact
• Participate in evaluating care strategies
• Document in Electronic Medical Records accurately
• Ensure timely delivery of reports
• Perform other assigned duties

Requirements

• Bachelor’s degree in nursing required
• Active RN license required; compact/multi-licensed preferred
• 5 years of experience in healthcare services
• 3+ years of clinical experience in healthcare settings
• Experience with cost of care initiatives
• Certified Case Management preferred
• Able to identify variances surrounding HCPCs, CPTs, ICD-10
• Experience with Medicare and Medicaid preferred
• Residence in assigned state

Benefits

• Competitive Paid Time Off
• Medical, Dental, Vision insurance
• Short Term/Long Term Disability
• 401K with match
• Other voluntary benefits as elected