Be an early applicantLess than 25 applicants

This job has closed.

Company

Original Job Post

Clearlink Partners · 3 days ago

Business Operations Subject Matter Expert

United States

Full-time

Remote

Senior Level

$130K/yr - $195K/yr

5+ years exp

Wonder how qualified you are to the job?

Maximize your interview chances

Health Care

Insider Connection @Clearlink Partners

Discover valuable connections within the company who might provide insights and potential referrals, giving your job application an inside edge.

Responsibilities

Conduct requirements gathering, workflow and gap analysis, solution design, software configuration, and producing related documentation

Post contract award discovery and scope confirmation.

Identifies potential gaps between client requirements and needed functionality

Creates workflows designed to optimize outcomes and support improved efficiency

Responsible for high-level validation and sign off points

Participates in design and discovery sessions offering best practice insights and recommendations

Collaborates on the development of project plans and deliverables

Establish an open, collaborative environment ensuring team members understand changes affecting work

Provides client training and related materials using a train-the-trainer approach

Partners with development to define and prioritize client enhancement requests

Collaborates with multiple internal/external technical teams to support system integration and automation

Participates in project status meetings

Provide direction for health plan market/ product level operational oversight, management and performance improvement

Leverage industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services

Deliver innovative, integrated solutions in support of client goals and engagements.

Provide delivery assurance support for engagements with assigned clients

Support or lead engagements ensuring completion of contracted services

Create and/ or manage to project plans

Write proposals/reports

Present to Client executives

Facilitate, advise and persuade key decision makers and influencers

Deliver concise, clear interpersonal communication to both internal and external audiences

Facilitate streamlined exchange of information with all levels of Clearlink and client organization(s)

Articulate performance across multiple projects with qualitative and quantitative results/ outcomes

Influence others to understand and accept strategies, goals and plans in response to changing business conditions

Develop methodologies and best practices to be applied across individual account strategies/ client plans.

Establish goals and track progress to ensure achievement

Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model

Identify opportunities to improve workflow, generate accurate, high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders

Develop or update policies and procedures as required to support business needs and requirements

Identify opportunities to streamline and/ or automate workflows for accurate, high quality production and improved results in cost savings, or outcomes measurement.

Coach and motivate staff to reach established engagement goals, deliverables and KPIs

Adapt processes, approach, plan and/ or activities in real time when targets, goals or timelines are at risk to ensure critical path activities are achieved

Support account management relationships with key client decision makers

Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary

Responsible for the engagement quality, maintaining appropriate resources, competency training and education of staff

Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager

Oversee compliance with internal client related audits, support Client preparation for external audits and surveys

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Health plan operationsProject managementGovernment payor environmentMedicareMedicaidHealthcare ExchangeData entryComputer skillsEnglish language proficiencyLeadershipTeam managementCommunicationField expertiseWorkflow developmentData conversionsPopulation identificationRegulatory complianceOffice software proficiencyProblem-solvingTeamworkStrategic thinking

Required

Bachelor’s Degree in Healthcare Administration or related field, Master’s degree preferred

5+ years progressive leadership experience in health plan operations, delivering results and managing teams and projects in a health plan setting and/or consulting environment; driving complex, multi-faceted, multi-site, application/operational change/improvement programs and activities.

3+ years of management experience in a government payor environment at a Director or equivalent level with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc)

Must be able to sit in a chair for extended periods of time

Must be able to speak so that you are able to accurately express ideas by means of the spoken word

Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices

Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse

Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types

Must be able to fluently communicate both verbally and in writing using the English language

Preferred

Fundamental conceptual problem-solving skills

Deep expertise in field of study

Working knowledge of workflow development specifically as it relates to functions performed within managed care plans

Experienced with the implementation and/or support of data conversions or interfaces

Experienced working on integrated, cross-functional teams

Proficiency managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery.

Managed care industry expertise in trends, innovation, operations, financing, costs, requirements, performance and outcomes

New product/ market design and implementation in the Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business

New population identification, program design and implementation to support needs/ requirements of increasingly complex memberships while ensuring stable operations and target outcomes

Strong understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures.

Work closely with concepts such as HIPAA, as well as State’s Department of Insurance, Federal and State Health and Human Services, CMS, NCQA, and URAC, to ensure compliance with complex regulatory structures.

Strategic thinker with ability to produce and manage system-wide change through influence and persuasion

Knowledge of project management principles, methods, and techniques

Ability to organize, prioritize, and manage multiple complex projects

Excellent communication skills both written and oral

High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred

None