Clinical Business Analyst

About the role

The Clinical Business Analyst serves as a Subject Matter Expert (SME) for InfoMC’s utilization management (UM) and care management (CM) applications, acting as a trusted advisor to payer clients. This role requires candidates who are a Registered Nurse (RN) or licensed healthcare professional with deep experience in payer-based UM/CM and familiarity with integrated health systems. The ideal candidate stays current on clinical trends, healthcare regulations, and Health Information Technology (HIT), including AI-driven analytics and interoperability standards (e.g., FHIR, MARS-E). They will guide clients in optimizing InfoMC’s solutions to meet clinical and regulatory needs, enhancing whole-person care and exceeding expectations.

What you'll do

·Clinical SME: Provide expert guidance on InfoMC’s UM/CM, resolving clinical issues and ensuring alignment with payer workflows.

·Product Feedback: Collaborate with product management, development, and implementation teams to recommend system enhancements based on clinical trends, AI capabilities, and regulatory requirements (e.g., CMS Interoperability Rule).

·Training Delivery: Develop and deliver engaging training for staff and clients on new features, AI-driven tools, and clinical workflows, emphasizing value for payers and providers.

·Solution Design: Actively contribute to designing, testing, and documenting clinical initiatives, ensuring seamless integration with client UM/CM processes.

·Sales Support: Assist sales teams in lead generation, pre-sale evaluations, and product demonstrations, showcasing clinical value to payers and providers (e.g., AI analytics, real-time provider portals).

·Documentation: Create detailed documentation on product configurations, clinical workflows, and best practices, collaborating with Product Management, Sales Engineering, and Client Services.

·Issue Resolution: Apply clinical and product expertise to troubleshoot and resolve client issues, ensuring high satisfaction and regulatory compliance.

·Industry Expertise: Stay current on HIT trends, clinical practices, and regulations, particularly in UM/CM, AI applications, and compliance standards like MARS-E and FedRAMP.

Qualifications

·Required Experience:

o5+ years of clinical experience in payer or integrated health systems, with direct UM/CM expertise.

o2+ years in the healthcare software industry, preferably with UM/CM platforms.

oRegistered Nurse (RN)/Clinical Background

·Education: Degree in Nursing (RN) or related healthcare field; advanced certifications (e.g., CCM, CPUM)

·Regulatory Knowledge: Strong understanding of clinical practices, federal/state regulations (e.g., CMS, HIPAA), and payer programs (Medicare Advantage, Managed Medicaid preferred).

·Technical Skills: Experience with healthcare IT systems, including AI-driven analytics, FHIR-compliant interoperability, and provider portal integration.

·Problem-Solving: Exceptional analytical and conceptual skills to identify innovative solutions, proactively address challenges, and drive cross-functional collaboration.

·Communication: Strong presentation and interpersonal skills to engage clients and stakeholders effectively.

·Eligibility: Authorized to work in the U.S.; no sponsorship provided.