Clinical Business Analyst
About the job
- At least 5 years of clinical experience in payer or integrated health systems, with direct utilization management or care management expertise.
- At least 2 years of experience in the healthcare software industry, preferably with utilization management or care management platforms.
- Registered Nurse or clinical background.
- Degree in Nursing or a related healthcare field.
- Strong understanding of clinical practices, federal and state regulations such as CMS and HIPAA, and payer programs; Medicare Advantage and Managed Medicaid knowledge is preferred.
- Experience with healthcare IT systems, including AI-driven analytics, FHIR-compliant interoperability, and provider portal integration.
- Analytical and conceptual skills to identify solutions and proactively address challenges.
- Presentation and interpersonal skills to engage clients and stakeholders effectively.
- Must be authorized to work in the United States; visa sponsorship is not provided.
- Provide expert guidance on InfoMC’s utilization management and care management applications, resolve clinical issues, and ensure alignment with payer workflows.
- Collaborate with product management, development, and implementation teams to recommend system enhancements based on clinical trends, AI capabilities, and regulatory requirements such as the CMS Interoperability Rule.
- Develop and deliver training for staff and clients on new features, AI-driven tools, and clinical workflows, emphasizing value for payers and providers.
- Contribute to designing, testing, and documenting clinical initiatives, ensuring integration with client utilization management and care management processes.
- Assist sales teams with lead generation, pre-sale evaluations, and product demonstrations, showcasing clinical value to payers and providers, including AI analytics and real-time provider portals.
- Create documentation on product configurations, clinical workflows, and best practices in collaboration with Product Management, Sales Engineering, and Client Services.
- Troubleshoot and resolve client issues using clinical and product expertise, ensuring client satisfaction and regulatory compliance.
- Stay current on health information technology trends, clinical practices, and regulations, particularly in utilization management and care management, AI applications, and compliance standards such as MARS-E and FedRAMP.
- Advanced certifications such as CCM or CPUM.
- Knowledge of Medicare Advantage and Managed Medicaid.
About the company
InfoMC provides a software-as-a-service (SaaS) platform for integrated care management in healthcare. It helps health systems, insurers, and providers coordinate and personalize care across medical, behavioral health, and social determinants, using features like prior authorization management, care coordination, and data analytics to improve patient outcomes while lowering costs in value-based care programs. The product works by orchestrating care workflows within a single platform, enabling organizations to streamline approvals, align care activities, and analyze data to drive better decisions. Its differentiators include an integrated, end-to-end solution that covers medical, behavioral, and social health, a strong emphasis on value-based care, and robust analytics and workflow tools that support care coordination at scale. The company aims to help clients achieve better health results and cost containment by delivering coordinated, data-driven care across the care continuum.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Conshohocken, Pennsylvania
Founded
1994
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Simplify's Take
What believers are saying
- MCG Health partnered with InfoMC on May 13, 2025, adding evidence-based utilization guidance.
- InfoMC said on September 8, 2026, Doctors HealthCare Plans earned a CMS 4.5 Star Rating.
- InfoMC refreshed its site in 2026 with microservices, FHIR integration, and Blazor UI messaging.
What critics are saying
- Maryland's 2026 lawsuit ties Incedo to Optum's Medicaid behavioral-health failure, risking contract bans.
- Optum's Maryland replacement went to Carelon in February 2024, showing customer defection risk.
- Maryland's case can trigger procurement scrutiny in Ohio and California, where Incedo history haunts bids.
What makes InfoMC unique
- Incedo integrates medical, behavioral, and social care into one shared member record.
- InfoMC preconfigures Incedo for CMS SNP models and configurable utilization workflows.
- Steven Vertrees has led product and technology since 2023, sharpening cloud and AI execution.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Retirement Plan
- Paid Holidays
- Paid Vacation
- Life Insurance
- Disability Insurance
- Remote Work Options
- Gym Membership
- Remote Work Options