Clinical Informaticist

[rnformatics]

Clinical Informaticist

Job Description
JOB CODE: NI8203E

Grade: 38

PURPOSE/SCOPE OF POSITION: The Nursing Informaticist will serve as the
primary Clinical Information resource in the documentation, implementation,
design, build, and maintenance of NIA's radiology UM system, business
processes, and documents related NIA's radiology benefit management
applications and/or projects.

RESPONSIBILITIES/DUTIES:

* Assists in writing project specifications from customer and/or departments
descriptions, as related to CPT codes and both internal and client medical
policies.

* Works with members of the project team, IT Department staff, and other
project team members to assist with the development of interface mapping
specifications.

* Manages the changes in workflow process that will need to be made with the
system changes, specific to coding and medical policies.

* Assists customers to identify and resolve problems with the application

* Follows through to ensure final resolution of problems, recommending longer-
term solutions when appropriate and communicating back to the individual
reporting the problem

* Provides consultative services to customers and application and development
teams as to workflow processes and technological solutions.

* Facilitates meetings and bringing working groups to consensus.

* Facilitates the two-way flow of information and communication for establishing
and maintaining understanding between Information Technology and Clinical
Operations department

* Maintains documentation in electronic format including but not limited to
Desktop tools/crosswalks local plan medical policy/vs NIA/CMS, CPT Claims
Matrix, and Clinical Review Guidelines "Clipit" criteria support in Informa

* Document and track file structuring and version control for maintenance of
policy, criteria, and desktops

* Develop and maintain database of client approved rationales

* Connect medical policies to denial rationales

* Development of improved tools for clinical review staff for use in
determinations as complexity surrounding local plan medical policy and CMS
specific policies change

* Analyze local plan medical policy for identification of gaps and or
recommendation for changes to either Client or NIA process/practice

* Develop criteria tool based on local plan policy for individual NIA clients

* Analyze CPT4 & ICD coding and provide recommendations to improve
processes and provide updates to the Informa Information Technology Staff

* Provide customer service and specialized information to NIA's clients.

* Confers with customers to keep them informed of status of their requested
projects.

* Serve as a focal point for the client in resolving inquiries and complaints
related to medical management and clinical review

* Assist the Client Integration team during new client integration by participation
as a policy and coding expert/resource

* Develop NIA criteria based on plan specific criteria

* Assist in beta-testing new system applications and other special assignments
as directed

KNOWLEDGE, SKILLS & ABILITIES:

* Excellent interpersonal, communication, presentations and analytical skills
are absolutely required

* The ability to interface effectively with other company departments

* Must be comfortable utilizing MS Office suite (i.e., MS Work, Excel,
PowerPoint, etc.)

* Working knowledge of the relationship between quality improvement and
process/ policy documentation.

* Broad exposure to a variety of clinical departments and patient care systems

* Strong problem and issue resolution experience

* Ability to be involved in multiple projects at the same time

* Good organizational skills, be able to prioritize multiple activities and
objectives in a rapidly changing environment, and deliver quality service

* Ability to articulate technical and user needs in a concise manner easily
understood by all.

EDUCATION & EXPERIENCE:

* BS in Nursing or equivalent degree is required. Masters degree in Nursing or
Clinical Informatics is preferred.

* RN with minimum of 5 years of experience in a clinical setting. At least 3
years of nursing background including Health plan, hospital, or medical
practice

* Experience with data analysis, data management associated with systems
evaluation, clinical research, and analysis tools and methodologies

* Experience in Medical policy documentation required

* Certification in Nursing Informatics through ANCC is desired

* UM experience preferred.



Physical Demands:

* The physical demands of this position are consistent with normal office
positions and are, therefore, considered light.