What are the responsibilities and job description for the Clinical Systems Admin Lead position at AmeriHealth Caritas Health Plan?
Responsibilities:
As a member of the Clinical Systems Admin team, the Clinical System Admin Lead provides leadership to, executes on, and works with Clinical Services system vendors and IS to ensure medical management applications function appropriately and that all upgrades, enhancements and implementations are successful.
The Clinical Admin Lead assists with guiding the day-to-day activities of the clinical admin team by managing the progress and results of the admin process, and onboarding new admins. In addition, this position is responsible for the timely and accurate review of system updates conducted by the Clinical Admins to promote consistency and to ensure compliance with business requirements as needed. The Clinical Systems Admin Lead will identify trends and provide coaching and feedback to both new and existing Admins.
- Sets up, maintains and protects the integrity of the system administration module, config tables and config catalogs for the medical management application.
- Coordinates system changes, including tables, options, programing of sentinel rules, and guidelines and oversees system testing to make sure systems are working as expected.
- Works with various IS and vendor project managers to coordinate creation and successful migration of enhancements and system upgrades
- Supports, maintains and updates correspondence in Client Letter for existing and new business
- Provides assistance to medical management training efforts, including training development and training delivery, as needed.
- Coordinates system auditing to confirm performance levels and identify potential areas for further investigation.
- Evaluates system reports, identifies/coordinates investigation and intervenes to resolve issues.
- Sets up, maintains, updates, as needed, provider portal rules and trigger tools. Maintains the integrity of the rules engine. Assist with training and support of the provider portal users.
- Participates and assists in the development of necessary protocols, policies and procedures, and operational strategies for Clinical Services.
Education/ Experience:
- Bachelor’s Degree (required). Master’s Degree (preferred).
- Registered Nurse (preferred).
- Utilization and Case Management experience, Business Experience (Insurance, Healthcare, Finance, Medical Systems), InterQual/Cerme Experience, Training Experience, and System Administrator Experience.
- Demonstrated knowledge of plan benefit information and managed care.
- Programming/application support experience required.
- Demonstrated ability to identify trends and conduct root-cause analyses and utilize data to facilitate changes to processes.
- Ability to provide constructive feedback with a focus on improved quality.
- Ability to communicate in a positive/professional manner both orally and written.
- Ability to follow detailed instructions with a high degree of accuracy.
- Ability to work independently and ensure deliverables are met within designated timeframes.
- Proven success leading a team (associates and external contractors) in a matrixed environment and cultivating and leveraging relationships with stakeholders at various levels within the organization.
- Demonstrated ability to work effectively with and manage external vendor partnerships.
- Working knowledge of Facets, SIR, Rightfax & EXP.
- Proficient PC skills in a Windows 10 based environment including MS Office (Word, Excel, Outlook, and Access.
- Proficiency utilizing SharePoint, Global Meet, Sentinel Rules, and Provider Portal.
- Understanding of Compliance and Confidentiality information.
