Clinical Operations Monitoring Analyst

Clinical Operations Monitoring Analyst

Regular

Exempt

GENERAL DESCRIPTION:

The Clinical Operations Monitoring Analyst is responsible for monitoring operational and regulatory processes to ensure compliance with applicable requirements, quality standards, and organizational policies. Supports operational excellence through data analysis, performance monitoring, reporting, process improvement initiatives, and quality oversight. Analyzes key performance indicators (KPIs), identifies trends and risks, develops recommendations for improvement, and supports leadership decision-making through timely and accurate reporting.

ESSENTIAL FUNCTIONS:

• Monitor operational and regulatory processes to ensure compliance with applicable federal, state, contractual, and organizational requirements. Serve as a subject matter resource regarding operational processes, reporting methodologies, and applicable regulatory requirements.
• Analyze performance metrics, key performance indicators (KPIs), trends, and operational data to identify opportunities for improvement and mitigate risks.
• Develop, maintain, validate, and standardize operational and regulatory reports, dashboards, scorecards, and presentations for leadership and operational committees.
• Support the development, implementation, and monitoring of corrective action plans (CAPs). Perform root cause analyses and recommend corrective actions to improve operational performance, quality outcomes, and regulatory compliance.
• Monitor quality standards through audits, sampling methodologies, and process reviews to ensure accurate categorization, documentation, investigation, and timely resolution of cases or transactions.
• Identify operational, compliance, and quality concerns and escalate findings to management for appropriate action.
• Support the monitoring of workload inventories, aging reports, turnaround times, and other performance indicators to ensure adherence to established service levels and regulatory requirements.
• Compile, analyze, and present statistical information to support operational reviews, audits, corrective action plans, and strategic initiatives.
• Collaborate with cross-functional teams to implement process improvements and operational efficiencies.
• Participate in regulatory audits, readiness activities, and data validation exercises as required.
• Support system enhancements, testing activities, and implementation initiatives impacting operational processes and reporting.
• Maintain documentation, reports, and records in accordance with established policies and procedures.
• Ensure all assigned responsibilities are completed within established quality standards, deadlines, and compliance requirements.

Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.

May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's degree, preferably in Business Administration, Health Services Administration, or related areas. Minimum of three (3) years of experience supporting MedicareAdvantage and Medicaid in health care operations, health insurance, regulatory compliance, grievances and appeals, claims administration, clinical operations, process improvement, reporting, quality management.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses: N/A

Other: Proficiency in Excel, reporting tools, and operational software is preferred.

Languages:

Spanish Advanced (comprehensive, writing and verbal)

English Intermediate (comprehensive, writing and verbal)

"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities."