Lets do great things, together! About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
The Sr Lead Clinical Configuration Analyst is responsible for the complex technical work related to the analysis, design, and maintenance of the configuration of the Clinical Care Advance system, and other systems as assigned. This position serves as a subject matter expert who proactively identifies and mitigates issues and opportunities for new configuration to support process and/or workflow optimization, in close collaboration with Healthcare Services and other departments. Pay Range
$89,313.39- $113,876.64 annually (depending on experience) Please fill out an application on our company page, linked below, to be considered for this position. Benefits : Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education: Bachelors degree in Nursing or Clinical Bioinformatics. In lieu of degree, equivalent education and/or experience may be considered. Minimum of 10 years of experience working with health plan system(s) configuration and operations; advanced knowledge of industry guidelines, requirements and best practice standards. Proven clinical experience with the administration of health plan benefits and medical management programs or services, including utilization management, care management, and appeals/grievances. Knowledge of and experience with change management methodologies, standards, and best practices. Ability to analyze process and document as workflows, perform gap analysis, and develop future state standardized workflows. Ability to understand and communicate the business needs at both clinical and technical levels, and translate them into configuration requirements. Ability to manage projects and initiatives independently end-to-end; facilitate meetings with participants at varying levels within the organization and meet agreed upon timelines with a high degree of accuracy. Strong communication, analytical, organizational and time management skills, including the ability to work well under pressure with constantly shifting priorities. Ability to maintain confidentiality and project a professional business image. Primary Functions : Gather and document requirements, performs needs assessment(s) for prioritization of new configuration requests or modifications, and develops configuration to meet the business needs; Manages and maintains all system configuration documentation. Monitor and review system edits and conduct advanced root cause analysis to identify issues and provide well thought-out recommendations for resolution, including those requiring multi-disciplinary technical skills. Interface and collaborate with peers and management in Healthcare Services and throughout the organization and industry to support configuration management best practices, system configuration life cycle management, project/program plans and tracking of configuration change and operational issues and resolution. Lead and manage configuration project timelines to meet agreed upon deliverables. Coordinates the preparation and execution of test plans to validate that configuration updates/system fixes are complete, accurate and that enhancements function as designed; serve as a resource during testing. Identify, manage, and communicate issues and risks, escalating as appropriate through areas affected. Assist others in gathering, assessing, and troubleshooting application issues including system defects and/or user error issues. Ability to independently and collaboratively lead system development processes focused on improvement, optimization, and transformation of processes including the implementation of best practice workflows, identifying compliance [or other] risk, addressing deficits in quality, and driving operational outcomes. Provide guidance or training as needed on available [system] options or features, general functionality and navigation, application limitations in order to promote optimal usability, interdepartmental transparency, and consistency. Apply clinical judgment and knowledge of the industry, federal, state, or plan-based requirements/regulations, and system functionality, when making decisions or recommending a course of action. Identify potential impact(s) of system enhancements, new plan/product initiation requirements, and/or operational process changes; provides guidance and support to business leadership and project team members. Support the development of various external system interfaces including claims operations, predictive modeling tools, clinical decision-making applications, and member/provider portals. Provide well thought-out recommendations for vendor enhancement of the system on a regular basis, test enhancements as they are delivered, and verify that enhancements are incorporated into ongoing configuration strategies. Serves as a liaison between business leadership, project team members, internal/external technical support, and project managers in the development, implementation, and maintenance of the application; based on relevance and priority determined by business operations, as well as requirements predicated by state and federal guidelines. Working Conditions & Contact with Others Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need. Internally with multiple departments. Externally with vendor and other health plans. Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our email.
