Clinical Business Analyst

About InfoMC, Inc.

InfoMC is a fast-paced, healthcare technology company delivering integrated care management and population health solutions to health plans and provider organizations. Our person-centered, “whole-person care” and provider approach addresses the behavioral, physical, and social drivers that impact a member’s health and enhances the interaction between plan, enrollee, and provider. Our solutions are designed to help our customers improve quality, reduce costs, and optimize health outcomes for their population.

At InfoMC, we are extraordinarily proud of the company we're building, not to mention our continuous efforts to create a Best Place to Work culture. Our people are InfoMC's biggest competitive advantage and we'll continue to invest in our team and people-first culture.

About the role

The Clinical Business Analyst serves as a Subject Matter Expert (SME) for InfoMC’s utilization management (UM) and care management (CM) applications, acting as a trusted advisor to payer clients. This role requires candidates who are a Registered Nurse (RN) or licensed healthcare professional with deep experience in payer-based UM/CM and familiarity with integrated health systems. The ideal candidate stays current on clinical trends, healthcare regulations, and Health Information Technology (HIT), including AI-driven analytics and interoperability standards (e.g., FHIR, MARS-E). They will guide clients in optimizing InfoMC’s solutions to meet clinical and regulatory needs, enhancing whole-person care and exceeding expectations.

What you'll do

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Clinical SME: Provide expert guidance on InfoMC’s UM/CM, resolving clinical issues and ensuring alignment with payer workflows.

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Product Feedback: Collaborate with product management, development, and implementation teams to recommend system enhancements based on clinical trends, AI capabilities, and regulatory requirements (e.g., CMS Interoperability Rule).

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Training Delivery: Develop and deliver engaging training for staff and clients on new features, AI-driven tools, and clinical workflows, emphasizing value for payers and providers.

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Solution Design: Actively contribute to designing, testing, and documenting clinical initiatives, ensuring seamless integration with client UM/CM processes.

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Sales Support: Assist sales teams in lead generation, pre-sale evaluations, and product demonstrations, showcasing clinical value to payers and providers (e.g., AI analytics, real-time provider portals).

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Documentation: Create detailed documentation on product configurations, clinical workflows, and best practices, collaborating with Product Management, Sales Engineering, and Client Services.

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Issue Resolution: Apply clinical and product expertise to troubleshoot and resolve client issues, ensuring high satisfaction and regulatory compliance.

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Industry Expertise: Stay current on HIT trends, clinical practices, and regulations, particularly in UM/CM, AI applications, and compliance standards like MARS-E and FedRAMP.

Qualifications

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Required Experience:

o5+ years of clinical experience in payer or integrated health systems, with direct UM/CM expertise.

o2+ years in the healthcare software industry, preferably with UM/CM platforms.

oRegistered Nurse (RN)/Clinical Background

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Education: Degree in Nursing (RN) or related healthcare field; advanced certifications (e.g., CCM, CPUM)

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Regulatory Knowledge: Strong understanding of clinical practices, federal/state regulations (e.g., CMS, HIPAA), and payer programs (Medicare Advantage, Managed Medicaid preferred).

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Technical Skills: Experience with healthcare IT systems, including AI-driven analytics, FHIR-compliant interoperability, and provider portal integration.

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Problem-Solving: Exceptional analytical and conceptual skills to identify innovative solutions, proactively address challenges, and drive cross-functional collaboration.

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Communication: Strong presentation and interpersonal skills to engage clients and stakeholders effectively.

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Eligibility: Authorized to work in the U.S.; no sponsorship provided.

Originally posted on Himalayas