Clinical Informatics Specialist (Remote, North Carolina Based)

The Clinical Informatics Specialist plays a crucial role at the intersection of healthcare and information technology. This role will be responsible for bridging the gap between the utilization management staff and information technology. The primary responsibility is to optimize the use of technology and data to enhance workflow efficiency, ensure compliance for both internal and external utilization teams and support clinical decision-making. The role involves analyzing, assisting with the design, implementing, and optimizing health information systems to ensure they meet the clinical and operational needs of the organization.

This is a full-time remote opportunity. There is no expectation of being in the office routinely, however, the selected candidate must be available to travel onsite as needed.

The selected candidate must reside in North Carolina.

Responsibilities & Duties

Workflow Analysis

• Analyze existing clinical workflows to identify areas for improvement and optimization by collaborating with UM supervisors, directors and SVP, and clinical trainer
• Develops and maintain process documentation to support front line staff
• Ensures system configuration accurately reflects workflows in collaboration with IT, compliance and Quality NCQA leadership
• Ensure workflows remain compliant with state regulatory and NCQA requirements in collaboration with compliance and Quality NCQA leadership

System Implementation and Integration

• Support Medical Management Systems launch, releases and enhancements by assisting in business requirement development in collaboration with IT and Clinical Trainer
• Support Medical Management Systems launch, releases and enhancements by assisting in testing
• Collaborate with IT system configuration teams to improve system functionality

Data Management

• Review, analyze and report Daily Operational and Control Reports from internal UM and delegates to ensure accuracy and operational excellence. Information is submitted on schedule as required to UM Leadership as frequent as daily, monthly and/or quarterly
• Identify and mitigate risks associated with the use of Clinical Informatics systems, including (but not limited to) interoperability of systems and system downtime
• Collect, analyze and interpret healthcare data to support decision-making processes to ensure quality performance and improve patient outcomes

Delegation Oversight

• Ensure compliance with UM components of delegate SOW activity including but not limited to monthly UM activity monitoring, programs description review, and IRR reporting
• Prepare delegate outcome reports for delegation oversight committee

Regulatory Compliance/ Audit Readiness

• Ensure the accuracy and integrity of the clinical data systems, while adhering to regulatory requirements (NCQA, EQRO, etc.)
• Facilitate appropriate UM readiness team for regulatory bodies above in preparation for internal/external record audits and site audits
• Own the documentation of compliance (bookmarking) with standards
• Oversight of Monthly State and NCQA Reporting prior to delivering to compliance and/or quality NCQA team

Minimum Requirements

Education & Experience

Required:

Bachelor's degree in nursing and five (5) years of experience in healthcare administration, Clinical Informatics, or a related field with a valid Registered Nursing license.

Or

A master’s degree in medicine, healthcare informatics, or a related field and five (5) years of experience in healthcare administration, Clinical Informatics or a related field with a valid NC clinical license.

RN or social work license (LCSW, LCMHC, LPA, or LMFT) is required for this role.

Preferred:

A Master's degree in Healthcare Informatics is preferred.

Certification in Health Informatics (e.g., Certified Health Informatics Systems Professional - CHISP) preferred.

Knowledge, Skills, & Abilities

• Clinical experience in a healthcare setting.
• Strong presentation, collaboration, and communication skills.
• Strong attention to detail, critical thinking, and problem-solving capabilities.
• Demonstrated skills in computer software, spreadsheets, databases and modeling programs.
• Experience collecting user requirements, translating to system feature enhancements.
• Knowledge of State and NCQA regulatory requirements.

Salary Range

81,375.00 to 135,625.00/Anually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

• Medical, Dental, Vision, Life, Long and Short Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Education

• Bachelors or better in Nursing
• Masters or better in Human Services

Licenses & Certifications

• Lic Clinical MH Counselor
• Lic Clinical Social Wkr
• Lic Marr & Family Ther
• Lic Psychological Assoc
• Registered Nurse