Company Description:
Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.
We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.
Position Responsibilities:
Specific
- Design, develop, and maintain optimal data pipeline architecture for data extraction, transformation, and loading from a wide variety of data sources using SQL, ETL tools, and cloud services on AWS/Azure.
- Design, develop, and maintain applications and solutions using FHIR (Fast Healthcare Interoperability Resources) standards to support data sharing and interoperability across healthcare systems
- Collaborate with external partners, including healthcare providers and software vendors, to facilitate seamless data exchange and integration
- Collaborate with business analysts, data scientists, and IT team members to improve data models that feed business intelligence tools, increasing data accessibility and fostering data-driven decision-making across the organization
- Participate in the development and maintenance of APIs for the exchange of healthcare data between systems.
- Implement data flow processes that ensure the accuracy and privacy of patient and member information, adhering strictly to HIPAA and other regulatory requirements
- Optimize and update existing ETL processes and data integration assets for better efficiency and reliability
- Contribute to the continuous improvement of FHIR implementation standards within the organization
- Stay up-to-date with the latest developments in healthcare interoperability standards and technologies
- Troubleshoot and resolve issues related to FHIR applications and integrations
- Conduct data analysis to troubleshoot data-related issues and ensure quality control of data flows
- Develop documentation for database support and data lineage, ensuring clarity and compliance with standards and practices
- Participate in continuous improvement efforts to enhance performance and provide increased functionality, including scheduled maintenance and security updates
- Assist in the development of data governance and quality processes to ensure data integrity and availability
General
- Provide support for health plan market/ product level operational oversight, management and performance improvement
- Leverage industry expertise and knowledge to provide high value consulting and advisory services
- Deliver integrated solutions in support of client goals and engagements.
- Provide delivery assurance support for engagements with assigned clients
- Support engagements ensuring completion of contracted services
- Create and/ or manage to project plans
- Prepare materials for presentation to Client executives
- Facilitate and inform key decisions through the use of data and industry best practice sharing
- Deliver concise, clear interpersonal communication to both internal and external audiences
- Facilitate streamlined exchange of information with engagement manager and client organization partner(s)
- Leverage proven methodologies and best practices in support of 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
- Manage and develop staff to reach established engagement goals, deliverables and KPIs
- Adapt processes, approach, plan and/ or activities in real time 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 ensuring 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
Position Qualifications:
Competencies:
- Proficient in SQL and experience with relational databases, as well as working knowledge of NoSQL databases
- In depth understanding of HIPAA EDI file types: 837 (Claim Transaction), 834 (Benefit Enrollment & Maintenance Transaction), 278 (Authorization Request & Response), 835 (Electronic Remittance Advice (ERA)), 276/277 (Claim Status / Response), 270/271 (Eligibility/Benefit Inquiry / Response)
- Strong knowledge of healthcare data standards, especially HL7 FHIR, and understanding of EHR systems.
- Proficient in programming languages relevant to FHIR development, such as Java, C#, or Python
- Familiarity with Python or Java for data processing
- Solid understanding of HIPAA and other healthcare-related regulatory standards is necessary
- Demonstrated ability to work with stakeholders to assess potential risks, formulate strategic data management plans, and implement solutions effectively
- Excellent problem-solving skills and attention to detail.
- Strong communication and collaboration skills, with the ability to work in a dynamic and fast-paced environment
- 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
Experience:
- Bachelor’s degree in Computer Science, Information Technology, or a related field or equivalent experience
- Minimum of 5 years of experience in a data engineering role with a focus on ETL development and data warehousing
- Experience with RESTful APIs and OAuth 2.0 security framework
- Strong experience with ETL tools (e.g., Informatica, Microsoft SSIS etc.) and cloud services (AWS, Azure, Google Cloud Platform)
- 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)
Physical Requirements:
- 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
Time Zone: Mountain or Pacific
Other Information:
- Expected Hours of Work: Friday 8 am – 5 pm PST; with ability to adjust to Client schedules as needed
- Travel: May be required, as needed by Client
- Direct Reports: None
- Salary Range: $115,000 – $170,000
EEO Statement:
It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.