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Overview

The Clinical Applications Administrator shall be responsible for understanding the intersection of IH HCS’s business requirements and clinical platform system(s) capabilities. The Clinical Applications Administrator will work with multiple internal departments, including but not limited to, Utilization Management, Case Management, Behavioral Health, Benefit Administration, Claims, Enrollment, Informatics, Servicing, Enterprise Content Management (ECM), IT, and Compliance with a focus on maximizing the clinical platform to provide for various business operational processes and regulatory requirements. In addition, the Clinical Applications Administrator will work as a business partner with various other IH project teams as needed to ensure that any technological implementations and enhancements will align with business goals and needs while demonstrating the ability to lead and influence customers and co-workers toward positive business outcomes and objectives.

The Clinical Applications Administrator will also be responsible for working together with vendor partners (i.e Medecision, Virtual Health, Healthwise, Wellsource, MCG) to provide assistance for resolution of issues, ensure that proper support SLA’s are met and that future technical roadmaps from these partners align with our corporate strategies.

Key to the Clinical Applications Administrator’s role will be the accountability for all HCS correspondence (UM, CM, BH, BA). This responsibility will include requirement elicitation and documentation, template configuration and maintenance, testing and compliance, as well as print vendor liaison.

Qualifications

• High school diploma or GED required. Associates degree preferred.

• Four (4) years of business operations and/or business systems experience required. Medical Management operations and/or system configuration experience strongly preferred.

• In depth knowledge of Clinical Care and/or Utilization and Case Management processes, benefit structures and applications and claims processing strongly preferred.

• Prior experience with clinical platforms and electronic medical records preferred.

• Operational expertise to understand and successfully consult with business units and external sources on capabilities of the applicable business systems required.

• In depth knowledge of IHA operating systems, platforms, and applications (Aerial, HealthRules, Macess, Siebel, Business Objects, RighFax) strongly preferred.

• Functional knowledge of system infrastructure, as it relates to HCS, and clinical platforms strongly preferred.

• General knowledge and understanding of medical and procedure coding formats.

• Knowledge of and experience with health care benefit plans. Ability to understand and interpret medical benefit contracts (member), provider agreements, medical policy, and regulatory determinations.

• Excellent written and interpersonal communications skills with emphasis on diplomacy, negotiation, persuasiveness, and interaction with multiple levels of management. Ability to lead and/or participate on multi-disciplinary project teams.

• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Essential Accountabilities

• Responsible for the administration, maintenance, development, configuration and testing of clinical systems. Note: sometimes this accountability must be performed during non-traditional work hours.

• Coordinate cross-functional implementation of software and upgrades; function as primary contact person during development and testing in applicable environments. Note: sometimes this accountability must be performed during non-traditional work hours.

• Participate on designated strategic and business critical project teams.

• Develop, configure, and maintain all HCS correspondence templates, including the elicitation and documentation of requirements to ensure regulatory compliance.

• Ensure appropriate configuration and data integrity within the clinical platform to drive accurate reporting.

• Coordinate the development and implementation of integrated system business rules and workflow processes within applications and other enterprise systems to ensure consistent and effective process outcomes across the organization.

• Provide system expertise to multiple departments, individuals, and vendor entities.

• Act as a liaison between the clinical system vendor, IT and the user communities of the clinical system supported.

• Ensure vendor service level agreements are met and that any adverse impact on service quality is kept to a minimum.

• Report and track all open issues with IT and/or the vendor through resolution. Provide daily monitoring and maintenance of business systems.

• Work with other cross-functional teams to maintain database management tools to ensure accurate and effective business processes are adhered to.

• Work with other members of the health plan performance management team to develop and implement strategies and appropriate configuration for managing the health of member populations.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $32.25 - $35.25 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (http://www.independenthealth.com/about/careers/additional-eeo-aap-information) for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.

We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.

We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here (http://www.independenthealth.com/about/community-report) to view our Community Reports.

Apply today and join us on the journey to a happier, healthier, and more inclusive community.

We are a drug-free workplace. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.