Clinical Guidelines Support Specialist

  • 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 We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach.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

Overview
The Clinical Operations department includes the teams responsible for development and publishing of HealthHelp clinical guidelines and clinical rules/algorithms that help automate utilization review of prior authorization requests.   

In the Clinical Rules team, we convert the clinical guideline content into interactive criteria controlled by a clinical rules engine. 

The Clinical Rules team is looking for a Clinical Guideline Support Specialist who can work collaboratively to bridge our clinical content and IT solutions, including translation of content into rules and successfully generating business requirements that support company-wide operational initiatives.


MAJOR RESPONSIBILITIES
•    Supports the application and organization of Department-related database(s), libraries, directories and archives.
•    Manages the online repository (ie, Word Press) for posting clinical guidelines and organization and content in the published clinical guidelines folder. 
•    Manages the update of non-clinical guideline content (eg, codes, disclaimer, copyright). 
•    Identifies, tracks and notifies colleagues/leadership of guideline-impacting updates from regulatory, licensing, accreditation and other pertinent entities (eg, CMS, FDA, NCQA). 
•    Facilitates process to license/purchase from external vendors, equipment/applications that support the Department’s operations (eg, EncoderPro, ClinicalKey, Paligo). 
•    Performs Customer Service Representative (CSR) testing for new guideline/rule changes and reports process/system improvement recommendations to leadership.
•    Maintains the Rules Suggestions reports and consolidates for leadership.
•    Monitors and escalates phone calls, voice mails, and emails received from external clients for guideline requests, questions, etc.
•    Attends all PAC meetings and creates/disseminates and maintains meeting documentation.
•    Organizes, maintains and communicates Physician Advisory Committee information.
•    Works with colleagues to document/maintain processes, workflows, policies and procedures.
•    Provides administrative support to Medical Operations Department, as assigned by manager.
•    Collaborates to resolve quality and compliance problems/trends.
•    Participates in organization’s Quality Management programs (related to guideline/rules) through provision of documentation, reporting, and meeting attendance.
•    Other duties as assigned to meet business needs.

Qualifications

Required:
•    Associates Degree in business, IT, healthcare, or related field
•    Proficient with use of Microsoft Office suite
•    Excellent interpersonal and customer service skills, with the ability to communicate efficiently with individuals at all levels
•    Strong analytical and critical thinking skills
•    Proven task management and execution management skills
•    Experience working in cross functional and matrixed management operating teams
•    Proven ability to succeed in a fast paced business environment with short deadlines

Preferred:
•    Bachelor’s Degree in business, IT, healthcare, or related field, preferred
•    Clinical experience, preferred
•    Content Management application/software experience, preferred

Additional Information

All your information will be kept confidential according to EEO guidelines.

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