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Senior Clinical Consultant



Category

Operations

Job Location

NA, NA

Tracking Code

8272021-3

Position Type

Full-Time/Regular

Certilytics provides sophisticated predictive analytics solutions to major healthcare organizations by integrating financial, clinical, and behavioral insights. Our team represents a dynamic infusion of multidiscipline, which includes actuarial, data and behavioral scientists, IT engineers, software developers, pharmacists, nurse clinicians, as well as experts in public health and the health insurance industry. Certilytics has extensive experience working with a diverse set of customers including large self-insured employers, health plans, pharmacy benefit managers, government programs, care management companies and health systems. These relationships with various data providers and customers allows for rapid data ingestion, validation and enrichment as well as streamlined delivery of analytic dashboards, outputs and visualizations to our customers. Our unique approach allows for the development of the most accurate financial, clinical and behavioral models in the industry.

 

We are currently looking for a Senior Clinical Consultant to join our team of mission-driven clinical innovators. This position will focus on clinical support of product design, product maintenance and enhancements, and delivery of analytic results supporting internal and external customers. 

Essential Functions

  • Participate in clinical team meetings and provide clinical support for quality, clinical, and operational improvement initiatives
  • Maintain responsibility of ensuring clinical standards and clinical guidelines are upheld, through continued research, review, and updates
  • Assume ownership for defined goals and responsibilities pertaining to regular and continued updates and changes for each product/process
  • Work with product managers on clinical prioritization in product design , enhancement , and testing
  • Create compelling interactive dashboards for internal and external customers to identify, design, recommend and execute solutions to deliver actionable information
  • Manipulate and analyze complex, high-volume, high-dimensionality data from varying sources using a variety of tools and data analysis techniques 
  • Develops appealing data visualizations leveraging multiple internal and external data sources (quantitative and qualitative), and drawing insightful recommendations for decisions makers
  • Assist with the development of reports and projects, including documenting methodology, designing reporting, and making recommendations based upon data analysis 
  • Identifies complex healthcare data problems or issues, research solutions, and implements steps to achieve higher level of efficiency for Certilytics analytics and product offerings 

Required Skills

Required Skills

  • Advanced degree in healthcare related field (PharmD, ARNP, NP, PA, MPH, MHA, etc.)
  • Minimum 5 years’ experience working in a healthcare setting, preferably with direct patient care experience
  • Minimum 2 years’ experience working with healthcare data with a firm understanding of healthcare coding standards/systems (e.g. Claims, NDC, ICD 9, ICD 10, LOINC, Medications, UCUM, UMLS, SNOMED CT, etc.)
  • Proficient in Microsoft Office suite, particularly Excel and PowerPoint
  • Clinical problem solving and decision making abilities, strong therapeutic knowledge
  • Deadline driven, results-oriented, accurate, and analytical
  • Ability to organize, prioritize, and maintain high quality work output in a fast- paced dynamic environment while working on multiple projects
  • Understanding of utilization management (UM) and prior authorization (PA)

Preferred Skills

  • Knowledge of data integration, software enhancements/planning, and agile methodologies
  • Dashboard experience/SQL experience
  • Working knowledge of HIPAA requirements, NCQA®, HEDIS®, PQA, PQRS, CMS Stars and state/federal requirements for managed care

 

Why Certilytics!

  • Access to one of the largest clinical datasets in the industry that includes medical claims, pharmacy claims, and laboratory data.
  • Impactful work. We’re big enough to have the freedom to take on interesting projects, but small enough that your work is always important and highly visible within the organization.
  • Remote Opportunity

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