Director, Clinical Rules

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Employees can work remotely
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

Summary: As a direct report to the Chief Medical Officer, this positions will be responsible for directing and supporting the translation of detailed clinical content into simplified algorithms to be used within a front-end, external-facing interface.

  • Translate clinical care guidelines across multiple specialty areas into simple but directive algorithms and pathways within an external facing user-interface.
  • Support the development of an easy-to-use user-interface
  • Support oversight and maintenance of clinical content database 
  • Think critically about creating easily modifiable systems and processes
  • Understand how to read and interpret clinical guideline content
  • Responsible for creating and owning a map between clinical content and user interface
  • Develop queue processes for update requests
  • Work with clinical resources to assign weighting and scoring as needed to various clinical scenarios

Qualifications

  • Knowledge clinical coding and billing (ICD and CPT)
  • Prior UM experience- 5 years
  • Minimum of 3 years of management experience is a plus
  • Strong verbal and written communication skills
  • Attention to detail
  • Need someone with some level of clinical experience
  • Collaborate with internal and external clinical experts
  • Familiarity with clinical guidelines and clinical concepts
  • Think critically about IT processes and designing the right level of specificity for end users
  • Some marketing or customer-facing background would be great (ex. you can only ask an end user 7 questions before they lose interest, etc)
  • Health literacy a bonus (goal is to make a user-friendly tool that is not at the level of literacy of physician specialty areas)
  • Proficient in excel

Additional Information

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