Health Services Clinical Configuration Analyst
Wellmark Blue Cross and Blue Shield
full-time
Posted on:
Location Type: Remote
Location: Iowa • United States
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Tech Stack
About the role
- Join Wellmark’s Health Services Business Support team in a consultative, clinically driven role
- Apply deep clinical and care management knowledge to analyze and improve UM business workflows
- Validate Health Services programs against business requirements and acceptance criteria
- Partner with medical directors and cross‑functional teams
- Review and evolve InterQual and custom clinical criteria
- Ensure Wellmark’s medical policy is translated into UM systems
- Evaluate and validate Health Services program activities against business requirements
- Analyze Health Services processes and foster ideation of new or enhancements to existing business processes
- Build and maintain constructive, interactive relationships with stakeholders and vendors
Requirements
- Active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota is preferred
- Ability to retrieve and analyze data using Excel and SQL
- Exposure to health services systems (e.g., Jiva) including system configuration
- Ability to coach and mentor others
- Bachelor’s degree in related field or direct and applicable work experience is required
- A minimum of 4 years of diverse experience in a health care, health insurance, or similar work environment is required
- Must have direct clinical care to the consumer experience, health and care management or related program experience
- Strong understanding of the health care industry
- At least 1 year of business and systems analysis experience is required
- Strong analytical skills and the ability to influence and lead others
- Must be able to understand complex processes and promote change
- Strong process improvement skills
- Strong written and verbal communication skills
- Proficient with Microsoft Office applications
Benefits
- Health Services Clinical Configuration Analyst is remote eligible
- Flexibility to work where you are most productive
- Ability to come into a Wellmark office periodically if desired
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisExcelSQLclinical criteria reviewbusiness analysisprocess improvementsystem configurationhealth care managementhealth services program evaluationclinical care
Soft Skills
coachingmentoringanalytical skillsinfluencingleadershipcommunicationrelationship buildingstakeholder engagementproblem-solvingchange promotion
Certifications
Registered Nurse (RN) license