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
Required Experience:
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.
Clinical Business Analyst • Conshohocken, PA, United States
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