Director, Clinical Systems Configuration

Job Summary:

The Director, Clinical Systems Configuration leads the analysis, design, development, testing and implementation of the company’s Guiding Care  platform and provides application support during advanced stages of implementation.

Essential Functions:

• Direct and lead configuration activities of a highly technical team by providing coaching and mentoring with a focus on quality, efficiency and collaboration; provide guidance in resolving technical issues
• Direct database configuration activities intended to modify and enhance the company operational database; activities include database set-up to support Prior Authorization , Care Management  and Clinical team needs
• Lead automation and upgradation efforts for Guiding Care platform
• Responsible for proactive analysis of internal operational, service and performance metrics, and proactively initiate performance improvement activities across the organization to achieve service and satisfaction goals   
• Create technical design and provide technical oversight to ensure the proper architecture and product performance is delivered; create architectural design and technical design documents
• Ensure appropriate approvals, testing, implementation controls and validation occur relative to new or modified records and files    
• Develop and maintain departmental policies, procedures and controls to ensure the integrity of the files, including HIPAA compliance
• Initiate and implement automated solutions to ensure optimal data quality
• Ensure that all policies and procedures are in place, are up to date, are consistent across department and CareSource and are compliant with all legal, Federal, State and Accrediting standards
• Ensure compliance with Model Audit Rules, State, Federal and Accrediting Agencies for all elements related to systems configuration data and processes
• Participate in national conferences and other events to stay current with industry changes
• Provide direction in the development of best practices configuration strategies to meet corporate goals related to operational efficiencies and excellence
• Work with business owners to achieve a system design that meets their needs and expectations 
• Ensure that supporting business processes and documentation exists as a basis for system logic
• Play a consultative role with business owners around configuration and items related to Clinical operations
• Perform any other job related instructions as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Master’s degree is preferred
• Minimum of five (5) years of health plan business or systems solutions experience is required
• Minimum of three (3) years of management experience is required
• Guiding Care experience is required
• Facets experience preferred

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office Suite to include Word, Excel, Access and Outlook
• Familiarity of the healthcare field
• High level of database and systems development knowledge
• Ability to translate business requirements into technical specifications
• Ability to manage and prioritize multiple tasks, promote teamwork and fact based decision
• Strong team and staff development skills
• Strong collaboration and conflict resolution skill sets
• Proven leadership with the ability to build relationships, collaborate and influence at all levels
• Strong process and analytical skills with the ability to articulate and define outcome measures that capture key performance metrics
• Strategic management skills
• Resiliency in a changing environment
• Strong decision making and problem solving skills
• Exceptional written and verbal communication skills with the ability to present information in a variety of different formats to all levels
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Ability to develop, prioritize and accomplish goals
• Excellent problem solving skills with attention to detail

Licensure and Certification:

• Six Sigma certificate or training preferred

Working Conditions:

• General office environment; may be required to sit/stand for long periods of time
• Ability to travel as required by the needs of the business

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.