Lead Clinical Nurse Analyst in San Antonio

UnitedHealth Group-posted 2 months ago
$89,900 - $160,600/Yr
Full-time • Mid Level
Hybrid • San Antonio, TX
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Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together. The Lead Clinical Analyst will work within the Suspect Services Team focusing on clinical suspecting, Machine Learning, and clinical actions. This position provides clinical and analytical guidance, performs major role in the development and implementation of business needs and oversees the work of Clinical Analysts.

  • Evaluates clinical and medical coding appropriateness of the suspecting engines with the goal of defining improvement needs and escalation to leadership.
  • Evaluates clinical actions/suspecting applications and/or systems and selects from a range of alternatives to determine the appropriate action to be taken.
  • Analyzes charts, diagrams, and reporting of the problem to be executed and defines system requirements in terms of business and technical capabilities.
  • Develops or assists in the development of work plans, task sequencing, and runs test cases to evaluate the extent of how tasks may be performed concurrently.
  • Works in tandem with the team leads to devise appropriate business and technical solutions.
  • Performs necessary investigations, analyses, and evaluations to determine project feasibility.
  • Performs routine duties independently; discusses or seeks approval on complex matters with the director manager.
  • Provides status, leads discussion of change requests, and organizes routine and ad-hoc meetings with Suspecting Governance, Working Group Committee and Clinical Actions leaders.
  • Works in concert with IT and other technical teams to perform system migration and system support functions.
  • Determine and oversee the needed research, interpretation, and analysis of pertinent healthcare data to identify new business opportunities and drive business decisions.
  • Lead user acceptance testing, coordinate system changes, and system upgrades.
  • Establish relationships with Business and IT Partners to lead team with gathering requirements and to ensure business expectations are met.
  • Process and documentation owner of data processes, analytical methodologies and dashboard logic to ensure transparency, reproducibility and team alignment.
  • Lead process improvements in team and application processes.
  • Perform all other related duties as assigned.
  • Registered or Licensed Vocational Nurse.
  • 4+ years of healthcare experience in one or more of the following areas: Claims Processing/Analysis, Medical Billing, Medical Coding, Nursing, or Clinical Operations.
  • 3+ years of Clinical Analytics experience.
  • 3+ years of process improvement experience.
  • 3+ years of advanced experience using Microsoft office applications, including databases, word-processing.
  • 3+ years of advanced experience using Visio® and Excel.
  • Excellent presentation skills with solid communication capabilities and practices, both oral and written.
  • Associate or bachelor's degree.
  • Certified Professional Coder.
  • Comprehensive benefits package.
  • Incentive and recognition programs.
  • Equity stock purchase.
  • 401k contribution.
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