Job Description
Overview
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The Care Management Operations Analyst serves as a subject matter expert and process leader, optimizing non‑clinical workflows across CM, CDM, and UM programs while advancing standardization, system improvements, and operational performance.
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What You'll Actually Do
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- Analyze and support end-to-end non-clinical workflows across CM, CDM, and UM programs
- Translate operational and clinical requirements into process maps, functional requirements, SOPs, and job aids
- Identify workflow gaps, inefficiencies, and risks impacting throughput, turnaround time, or documentation quality
- Support intake, referral, authorization, follow-up, and task management workflows
- Develop and maintain operational reporting, dashboards, and performance metrics
- Support workflow automation and system optimization initiatives
- Support planning, testing, and release activities for system and process changes
- Support implementation of new tools, enhancements, regulatory requirements, or client initiatives
- Partner with clinical, quality, IT, and analytics teams to ensure operational alignment
- Support audit and compliance readiness through process standardization and traceability
- Supports established workflows with guidance
- Documents business processes, requirements, and procedural updates
- Assists with reporting, data validation, and workflow monitoring
- Participates in automation and improvement initiatives as a contributor
- Builds foundational knowledge of CM, CDM, and UM operations
- Maintains high-level of understanding of regulations to support staff education
- Remain current with best practice models and current processes to be able to provide instruction to staffÂ
- Maintains high-level of cohesiveness within the team and professionalism as a representative of the department
- Other related duties as assigned to meet departmental and Company objectives
- Demonstrate proficiency in Microsoft Office Suite
- Ability to meet productivity, quality, and turnaround times daily
- Maintain HIPAA compliance and confidentiality in accordance with company policies
- Complete all required annual training within designated timeframes
- Same as level I with additional expectations and training in the department
- Serves as a subject matter expert across CM, CDM, and UM workflows
- 3-5 years experience of managed care experience
- Serves as a mentor
- Independently analyzes and redesigns workflows to improve efficiency and outcomes
- Development of scripts and automated tools
- Same as level I and Level II with additional expectations and training in the department
- Leads process improvement and automation initiatives
- Designs advanced reporting, analytics, and dashboards
- Translates ambiguous requirements into functional and technical deliverables
- Anticipates operational risk and downstream workflow impacts
- Supports complex implementations, audits, and regulatory initiatives independently
- Develops automation scripts and technical solutions to support operational workflows
- Understands the complexities of teaching a wide variety of staff and adapts teaching skills and level to audience
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