Healthmap Solutions

<div><div><span style="text-decoration: underline;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><em><strong>Position Summary:</strong></em></span><br /><div><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">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.</span></div></div><div><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"> </span></div><div><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="text-decoration: underline;"><em><strong>Responsibilities:</strong></em></span> </span></div><div><ul><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Analyze data and reports to identify Healthmap Solutions members that would benefit from care navigation support to reduce inappropriate utilization patterns to improve member health outcomes and reduce cost of care</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Document clinical and, if appropriate, Social Determinants of Health (SDoH), summary of the high-cost and/or high-utilization</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Develop and provide structured action steps for the Clinical Community Liaison, Care Navigators, and Quality Practice Advisors, etc. by utilizing critical thinking skills, clinical assessment skills and acquired knowledge</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Understand Clinical Review such as medical necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Records Reviews </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Working knowledge of cost of care and impact of readmissions</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Active participant in evaluating the High-cost/High-utilizer and Transition of Care strategies</span></li><li style="line-height: normal;background: white;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Document in Electronic Medical Records (EMR) and various technology platforms with accuracy and high-level proficiency to ensure analytics cover components needed for required responsibilities </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Ensure timely and successful delivery of reports </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Perform other duties as assigned</span></li></ul></div><div><span style="text-decoration: underline;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><em><strong>Requirements:</strong></em></span></div><div><ul><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Bachelor’s degree in nursing required</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Active, unrestricted RN license required; compact and/or multi-licensed preferred</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">5 years of progressive experience in healthcare services, clinical operations, quality, or care management</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">3 + years of clinical experience within any healthcare setting {Acute Care, Outpatient, etc.}</span></li><li style="line-height: normal;background: white;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Experience with of cost of care initiatives that decrease admissions and readmissions </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Certified Case Management (CCM) preferred </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Able to identify variances surrounding HCPCs, CPTs, ICD-10 preferred</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Experience with Medicare and Medicaid preferred </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Residence in assigned state</span></li></ul></div><div><span style="text-decoration: underline;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><em><strong>Skills:</strong></em></span></div><div><ul><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Excellent verbal, written, listening and presentation skills</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Ability to show compassion and empathy for patients</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Demonstrated interpersonal relationship skills that drive collaboration toward organizational goals</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Ability to multitask, prioritize, and create solutions in a fast-paced environment</span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Strong critical thinking and analytical skills </span></li><li style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint</span></li></ul></div><div><span style="text-decoration: underline;font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"><em><strong>Travel:</strong></em></span></div><div><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;"> </span></div><div><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">Limited Travel, scheduled per needs of the business</span></div></div><p><br /><span style="font-family: sans-serif , arial , helvetica;font-size: 11.0pt;">#LI-REMOTE</span></p>