Clinical Business Rule Analyst - Eden Prairie, MN

Optum is developing an exciting new system intended to help stakeholders in health plans and contracted clinical practices better leverage the power of fully harmonized, multi - source patient information in clinical management workflow automation. This system’s functionality will evolve over time to help users more efficiently and effectively manage care for defined cohorts of patients based on its ability to rapidly ingest / harmonize data different kinds of data and then run clinical management business rules in real time.  Systems users will ultimately spend less time gathering and reconciling information as a basis for clinical management of individual patients and populations, and more time executing clinical management processes for more patients.
 
As a Clinical Business Rule Analyst, you will leverage your knowledge of clinical data management processes and related business rules development to help structure new workflows that use data and technology to automate a wide range of clinical management processes.  For example, you may define the business rules that optimize workflows for care coordinators in an ACO or you may define the business rules for a workflow process for automating prior authorization of certain common procedures requiring clinical review. 
 
As a key resource within a multi - disciplinary scrum team, you must maintain a high degree of accuracy along with attention to detail, an aptitude for persistence, excellent verbal and written communication skills, strong interpersonal skills and the ability to deliver on time. Success in this role will require ability to prioritize, multi - task, plan ahead, as well as being flexible, resourceful, and self - driven.
 
Primary Responsibilities:


Stay current and knowledgeable about best practices in clinical management processes (case management, concurrent review, medical necessity review, etc.) within payers and within providers who have delegated financial risk

Review data analysis of existing processes

Help perform program efficacy analyses

Perform stakeholder engagement and communication to help test and refine requirements

Identify process improvements, based on available data, role objectives and program outcomes

Work with clinical analysts and platform developers to structure improved clinical management workflow

Participate in sprints with multi - functional team to translate optimized workflows into actual system functionality

Work in sprints with multi - functional team to help test and validate optimized clinical management workflows
 

Required Qualifications:

Bachelor’s degree
4+ years  of experience working within payer and / or provider / practice based clinical management functions
4+ years working with clinical data and data sets
Data analysis relationship management
4+ years working with queries, analyzing provider claims, membership, lab, and pharmacy data, medical claims
4+ years of experience performing data analysis and making data - driven analytical decisions
2+ years of experience performing statistical analysis with experience working with statistical software (e.g., SPSS; Minitab)
Experience facilitating and leading meetings
Being a team player willing to cover and learn other roles and functions
Intermediate or Advanced proficiency MS Access, SAS, SQL or other statistical analysis software
Intermediate or Advanced proficiency with MS Excel
Intermediate proficiency in MS Power Point
 
Preferred Qualifications: 

Experience evaluating effectiveness of Clinical management processes and programs
Healthcare Effectiveness Data and Information Set (HEDIS) knowledge
Experience applying Six Sigma or other quality improvement techniques in clinical management settings
Experience with Agile environment
Demonstrated and proven experience in clinical data management process
Detail oriented, with careful attention to work processes and focus on delivering high - quality results
Strong quantitative background and highly analytical with a genuine interest in analyzing and interpreting data for purposes of clinical management process improvement
Proficiency with MS Visio
Strong time management, organizational, and prioritization skills with the ability to balance multiple priorities, track and manage requests and deliverables, and meet deadlines
Ability to multi - task in a dynamic setting and work well under pressure
Strong communication skills, verbal and written
Anticipates team mate needs and proactively develops solutions to meet them
Strong problem solving skills with the ability to independently develop innovative solutions
Ability to work both independently and within a team setting
Ability to influence without authority
Ability to learn quickly and desire to take on new challenges
Strong desire to make continuous improvements in all areas of responsibility
Takes ownership of issues with ability to follow through and be resourceful on all responsibilities
Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: Clinical Business Rule Analyst, Analyst, SAS, SQL, Eden Prairie, MN, Minnesota