Clinical Services Analyst

Remote - Shift: MON - FRI 8:00am - 4:30pm CT (can be located anywhere in US, but will need to work CT hours)

Safety-Sensitive

Questionnaire:
- Please add city and state at the top of the resume.
- Do they have reliable internet at home?
- Do they have a quiet, secure place to work at home remotely?
- Do they have PBM experience? If so, how many years?

Interview Process: 1 IV, Teams (on-camera), 60 mins; Possible 2nd Round IV if needed

POSITION SUMMARY: Briefly describe the primary functions of the position (i.e., the key areas of responsibilities and key interactions, overall decision-making authority, budget impact, strategic and operational impact,
business complexity).

The Analyst, Clinical Services is responsible for ensuring that any changes to Medicare Part D Coverage Determinations, Appeals, Organization Determination and CTM/GRV systems, processes, letters, workflow, and business change requests are appropriately completed. This is a key role to ensure that clients, members and internal colleagues have CMS compliant tools that allow for complete and accurate processing of CD&A cases. The Analyst may work with account teams, implementation managers, business requestors, and/or the UM Development/Medical Affairs teams to ensure that business intent is appropriately interpreted and then configured correctly and tested in the operating system. The Analyst must be able to research and solve complex problems, perform root cause analysis, provide feedback and solutions for meeting our project plans and monthly/quarterly release timelines. The Analyst is accountable for the process/task to be completed appropriately, consistent with the request intent, and on time.

PRIMARY DUTIES AND RESPONSIBILITIES:
The top four or four primary responsibilities of the position in the space provided below:
1. Configuration and self-test of Med D CD&A System
2. Deployment night Pre and post deployment report validation
3. ServiceNow ticket and issue research for CD&A, CTM/GRV operations (7days)
4. Case assignment, some training/BSR/CMS/ System Change meetings

EDUCATION:
- High School or Equivalent required
- Bachelor's degree preferred

PRIOR WORK EXPERIENCE:
- 0 to 3 years

ESSENTIAL QUALIFICATIONS:
- Basic problem solving and decision making skills

REQUIRED SKILLS & QUALIFICATIONS:
1. Organize, prioritize, and manage multiple tasks with a high level of detail.
2. Excellent Oral and Written communication skills to be utilized in a consultative fashion.
3. Strong Analytical Skills (Manipulation of data/ Testing and Configuration.)
4. Self-motivated individual with a quick learning curve on complex materials.
5. Ability to work in a high production, time sensitive environment.
6. Computer Knowledge including but not limited to Microsoft office products, Windows based operations.

Preferred:
- PBM Knowledge
- Analytical Skills
- Ability to work in team and independent environments
- Time Management Skills
- Medicare Knowledge
- Able to thrive in time sensitive situations

Position Summary:

The Analyst, Clinical Services is responsible for ensuring that any changes to Medicare Part D Coverage Determinations, Appeals, Organization Determination and CTM/GRV systems, processes, letters, workflow, and business change requests are appropriately completed. This is a key role to ensure that clients, members and internal colleagues have CMS compliant tools that allow for complete and accurate processing of CD&A cases. The Analyst may work with account teams, implementation managers, business requestors, and/or the UM Development/Medical Affairs teams to ensure that business intent is appropriately interpreted and then configured correctly and tested in the operating system. The Analyst must be able to research and solve complex problems, perform root cause analysis, provide feedback and solutions for meeting our project plans and monthly/quarterly release timelines. The Analyst is accountable for the process/task to be completed appropriately, consistent with the request intent, and on time.

Duties:

- Configuration and self-testing of Med D CD&A System. Case assignments
- Assists in executing the planning, implementation, and execution of Clinical Service operations to ensure compliance with regulatory requirements in support of the organization's objectives.
- Analyzes reports and resolves trends, identifies risks, and provides solutions to managers and senior individual contributors.

Experience:

Required 0 to 3 years related work

Required Skills and Qualifications:
1. Organize, prioritize, and manage multiple tasks with a high level of detail.
2. Excellent Oral and Written communication skills to be utilized in a consultative fashion.
3. Strong Analytical Skills (Manipulation of data/ Testing and Configuration.)
4. Self-motivated individual with a quick learning curve on complex materials.
5. Ability to work in a high production, time sensitive environment.
6. Computer Knowledge including but not limited to Microsoft office products, Windows based operations.

Preferred:
- PBM Knowledge
- Analytical Skills
- Ability to work independently or in team environment
- Time Management Skills
- Medicare Knowledge
- Able to thrive in time sensitive situations.

Education:

Bachelor's degree preferred
High School Diploma or Equivalent Experience