Guiding Care Configuration Analyst
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Job Title - Guiding Care Configuration Analyst/Lead
Skill:
ROLE: Guiding Care Configuration Analyst/Lead Config SME for Utilization Management, Care Management/Including Gaps In Care/Care Pathways, Appeals & Grievances, Correspondence/Letters, Population Health/Risk Scores, Alerts/Activities/Rules, Health Risk Assessments
Essential Functions:
Produce gap analysis on rules/alerts/scripts/configuration, and recommend best practice solutions for Care Management, Utilization Management, and Grievance and Appeals
Guiding Care (GC) hierarchy
Configurations and Workflows for Functional Areas supported by Guiding Care
Utilization Management , Care Management / Including Gaps In Care / Care Pathways, Appeals & Grievances, Fax Optimization, Provider module review
Correspondence/Letters, Population Health / Risk Scores, Alerts/Activities/Rules, Health Risk Assessments
Recognize inconsistencies and gaps in guiding care tree structure
Through research and analysis, identify systems, possible letters/ reports in ,
Perform root cause analysis
Five (5) years of experience working with Guiding Care or other similar enterprise systems is preferred
Five (5) years of experience with the healthcare environment (Medicaid/Medicare) is preferred
Competencies, Knowledge, and Skills:
Ability to establish effective working relationships with stakeholders at all different levels
Understanding of project lifecycles coupled with the software development lifecycle, including processes, techniques, continuous delivery, tools agile, test-driven development, and waterfall
Thorough understanding of business analysis principles
Effective problem-solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Strong interpersonal skills including excellent written and verbal communication skills; listening and critical thinking
Ability to effectively prioritize and execute tasks while working both independently and in a team-oriented, collaborative environment