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Harris Health · 1 day ago

Sr Clinical Performance Adherence Analyst

Houston, TX

Full-time

Onsite

Senior Level

5+ years exp

Harris Health is a non-profit Managed Care Organization serving over 400,000 members through various health programs. The Sr Clinical Performance Adherence Analyst is responsible for monitoring and reporting on clinical performance metrics, ensuring adherence to policies and regulatory requirements, and collaborating with stakeholders to improve service delivery.

Hospital & Health Care

H1B Sponsor Likely

Responsibilities

Responsible for monitoring and reporting the activities of Medical Affairs: Service Coordination, Case Management and Utilization Management programs, to ensure all clinical documentation and operational activities to include quality metrics, contractual regulatory, assessment, and operational reporting requirements are met for STAR, STAR+ Plus, DSNP and Marketplace

The Clinical Performance Adherence Specialist will perform investigation of performance inefficiencies and deficits, analyze data for trends, identify process gaps, and report all potential risks and root causes

The Clinical Performance Adherence Specialist will develop and draft proposals to mitigate process gaps to leadership

Collaborates with internal and external stakeholders to respond to regulatory agency requests (i.e., HHSC) for monthly and annual reporting

Analyze, track, trend, and report on metrics developed within the Model of Care for all lines of business

Develop and utilize approved auditing tools while conducting monthly audits on Medical Affairs staff and clinical documentation

Responsible for meeting required performance and quality metrics and ensure reviews, deliverables, and reports are completed within established regulatory, and state requirements

Provides reports and feedback to management regarding performance of Medical Affairs staff regarding adherence to policies and procedures, regulations, and standards

Proactively identify risks and mitigation activities thus ensuring contract requirements are met

Identify opportunities for improvement, via root-cause analysis, while utilizing a process improvement cycle to recommend solutions for identified problems

Develop and/or revise training materials when systematic deficiencies are identified

Draft and recommend updates to policies and procedures to reflect changes to regulatory and accreditation standards, while monitoring regulatory requirements on an ongoing basis

Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans, and other duties as assigned

Qualification

Clinical InformaticsAuditingComplianceMicrosoft OfficeHealthcare ExperienceProblem AnalysisAnalytical ThinkingVerbal SkillsAttention to DetailResults OrientedWriting SkillsInterpersonal Skills

Required

Bachelor's degree or higher in Nursing, Social Work, Clinical Informatics, or related Health Sciences

5 years in healthcare setting, including 2 years in managed care organization

Strong verbal and written skills

Proficient Computer Literacy with the ability to use Network Search Engines

Ability to work autonomously in a fast-paced environment with multiple projects and deadlines

Ability to prioritize amongst competing priorities

Preferred

Licensed Clinician such as: Registered Nurse, Licensed Social Worker, Licensed Vocational Nurse, or a Masters Degree or Higher in Business, Population Health, or Healthcare

Auditing, Compliance, And/or Analytics Experience

Proficiency in business monitoring, workflow automation, and research tools

Company

Harris Health

Glassdoor3.8

At Harris Health, we champion better health for our patients, their families and our community, by connecting all to an integrated healthcare system that provides high-quality healthcare.

Founded in 1966

Bellaire, Texas, US

5001-10000 employees

http://www.harrishealth.org

H1B Sponsorship

Harris Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (11)

2024 (6)

2023 (6)

2022 (7)

2021 (9)

2020 (7)