This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Care Management Operations Analyst serves as a subject matter expert and process leader, optimizing non-clinical workflows across CM, CDM, and UM programs while advancing standardization, system improvements, and operational performance.

• Analyze and support end-to-end non-clinical workflows across CM, CDM, and UM programs
• Translate operational and clinical requirements into process maps, functional requirements, SOPs, and job aids
• Identify workflow gaps, inefficiencies, and risks impacting throughput, turnaround time, or documentation quality
• Support intake, referral, authorization, follow-up, and task management workflows
• Develop and maintain operational reporting, dashboards, and performance metrics
• Support workflow automation and system optimization initiatives
• Support planning, testing, and release activities for system and process changes
• Support implementation of new tools, enhancements, regulatory requirements, or client initiatives
• Partner with clinical, quality, IT, and analytics teams to ensure operational alignment
• Support audit and compliance readiness through process standardization and traceability
• Supports established workflows with guidance
• Documents business processes, requirements, and procedural updates
• Assists with reporting, data validation, and workflow monitoring
• Participates in automation and improvement initiatives as a contributor
• Builds foundational knowledge of CM, CDM, and UM operations
• Maintains high-level of understanding of regulations to support staff education
• Remain current with best practice models and current processes to provide instruction to staff
• Maintains high-level of cohesiveness within the team and professionalism as a representative of the department
• Other related duties as assigned to meet departmental and Company objectives
• Demonstrate proficiency in Microsoft Office Suite
• Ability to meet productivity, quality, and turnaround times daily
• Maintain HIPAA compliance and confidentiality in accordance with company policies
• Complete all required annual training within designated timeframes
• Same as level I with additional expectations and training in the department
• Serves as a subject matter expert across CM, CDM, and UM workflows
• 3-5 years’ experience of managed care experience
• Serves as a mentor
• Independently analyzes and redesigns workflows to improve efficiency and outcomes
• Development of scripts and automated tools
• Same as level I and Level II with additional expectations and training in the department
• Leads process improvement and automation initiatives
• Designs advanced reporting, analytics, and dashboards
• Translates ambiguous requirements into functional and technical deliverables
• Anticipates operational risk and downstream workflow impacts
• Supports complex implementations, audits, and regulatory initiatives independently
• Develops automation scripts and technical solutions to support operational workflows
• Understands the complexities of teaching a wide variety of staff and adapts teaching skills and level to audience
• Demonstrate expert-level proficiency in Microsoft Office Suite, Share Point, Power BI, Air Table

Qualifications

• Bachelor’s degree preferred, or minimum three years of formal training experience in health care service capacity
• Demonstrated success leading or contributing to cross‑functional process improvement initiatives
• Experience developing or supporting automation, workflow optimization, or reporting enhancements
• Ability to translate ambiguous operational needs into clear process or technical requirements
• Experience supporting complex implementations, regulatory changes, or client onboarding activities
• Working knowledge of standard office software and systems
• The ability to work on multiple screens, and proficient typing skills
• Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
• Ability to speak clearly and convey complex or technical information in a manner that others can understand
• Ability to work independently and utilize written resources to solve problems
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Excellent verbal and written communication skills for upward and downward conversations

Requirements

• Ability to perform the essential job functions safely and successfully with or without reasonable accommodation
• Ability to maintain regular, punctual attendance
• Ability to sit for 6-8 hours
• Constant use of computer keyboard and mouse; repetitive use of both hands
• Occasional to frequent twisting of neck; occasional bending of neck and at waist

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health