Clinical Operations Analyst
About The Role
The Clinical Operations Analyst serves as the operational and technical backbone of the Medical Management department. This role bridges clinical program operations, platform configuration, data analytics, and training to ensure that BHPS’s clinical teams—spanning Utilization Management (UM), Case Management (CM), Disease Management (DM), and Medical Director (MD) operations—have the systems, workflows, reports, and documentation they need to deliver high-quality, compliant, and scalable services.The ideal candidate understands managed care clinical operations from the inside, can configure and optimize clinical platforms (particularly JIVA/ZeOmega), writes SQL to build operational reports, and drives solutions through training materials, workflow documentation, and cross-functional collaboration.
Primary Responsibilities
- Configure the JIVA platform to meet internal business needs, client-specific requirements, and regulatory standards across UM, CM, DM, and Casualty lines of business.
- Serve as a system administrator and super user for ZeOmega, supporting configuration, troubleshooting, and day-to-day operational needs for all clinical teams.
- Lead and participate in UAT testing across staging and production environments; validate new functionality, workflow changes, and platform updates for accuracy and compliance.
- Submit, track, and prioritize Karmic/MITS tickets for clinical system needs.
- Support the ongoing initiatives of the clinical platform across all existing clinical teams, ensuring milestones and go-live targets are met.
- Provide super user support in go-live rooms during initial department launches.
- Develop and maintain SQL queries and operational reports to support daily production oversight across UM, CM, DM, and MD teams.
- Partner with analytics teams to ensure data accuracy, reporting alignment, and consistency across platforms.
- Build out daily oversight and production reports tied to the new clinical platform.
- Define standard operating procedures (SOPs) for day-to-day operational reporting.
- Author, maintain, and update clinical workflows, desktop procedures, and job aids for UM, CM, and DM operations.
- Develop and deliver training materials—both for current-state and future-state processes—supporting system transitions and new program rollouts.
- Support internal knowledge sharing related to JIVA/ZeOmega system updates and best practices.
- Participate in accreditation readiness activities including mock audits, artifact development, and compliance training (URAC/NCQA).
- Collaborate with clinical, IT, product, and business teams to translate operational needs into platform capabilities and process improvements.
- Provide cross-functional support to adjacent teams (e.g., Intake) with training, reporting, and workflow design as needed.
- Support clinical leadership in the identification and implementation of program enhancements and new initiatives.
Essential Qualifications
- Bachelor’s degree in healthcare administration, information systems, business, or a related field (or equivalent experience within a managed care environment).
- 3+ years of experience in clinical operations within a managed care, TPA, or health plan setting, with direct exposure to UM, CM, or DM workflows.
- 2+ years of hands-on experience with clinical platforms, with strong preference for JIVA/ZeOmega or comparable care management/utilization management systems.
- Proficiency in SQL for query development, operational reporting, and data analysis.
- Demonstrated experience in system configuration, platform testing (UAT/production), and reporting tool development.
- Strong understanding of healthcare operations, clinical workflows, and regulatory/compliance requirements.
- Experience creating workflows, desktop procedures, job aids, and training materials for clinical or technical audiences.
- Project management experience with the ability to manage multiple priorities and meet aggressive timelines.
- Experience with accreditation bodies (URAC/NCQA) and compliance artifact development.
- Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook); Access/VBA experience a plus.
- Excellent problem-solving skills, attention to detail, and the ability to work independently in a fast-paced environment.
- Strong interpersonal and communication skills with the ability to work cross-functionally with clinical, technical, and business stakeholders.
Preferred Qualifications
- Experience with health plan operations spanning commercial, Taft-Hartley, and/or casualty/workers’ compensation lines of business.
- Familiarity with CPT, HCPCS, and ICD-10 coding systems.
- Experience with business requirements documentation (BRDs), SOPs, and clinical program artifact development.
- Familiarity with Agile methodologies and product lifecycle processes.
- Experience with workforce management reporting and production tracking.
- Excellent self-starter comfortable with ambiguity and the ability to function with a high degree of independence.
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
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