Associate Systems Analyst - IT Health Plan

• 1. Analysis and Assessment:  Foundational experience in analyzing business needs, documenting functional specifications, and supporting alignment with technical solutions. Capable of utilizing data insights to assist in decisions related to software procurement, installation, and configuration. Demonstrates growing proficiency in utilizing tools such as process maps, workflow diagrams, and data analytics to support system design, training, and problem resolution.

  2. Attention to Detail: Demonstrates foundational skills to troubleshoot and test systems, assisting in identifying and resolving potential issues to support functionality and reliability.

  3. Communication, Relationship Building, and Teamwork: Demonstrates written and verbal communication skills to convey technical information clearly. Applies interpersonal skills to build relationships and support collaboration within teams. Actively contributes to a positive team dynamic by participating in group problem-solving, sharing knowledge, and fostering a collaborative environment.

  4. Adaptability and Change Management:  Demonstrates ability to respond to unexpected changes and system issues, applying foundational coping skills to assist in minimizing disruptions and maintaining operations.

  5. Time Management:  Shows ability to prioritize and manage multiple tasks and deadlines, working to ensure timely and accurate completion while contributing to team goals.

  • Clinical background or licensure strongly preferred, such as RN, LPN, PharmD/RPh, Pharmacy Technician, or comparable clinical experience.
  • Experience with Utilization Management, Pharmacy, prior authorization, Medical Management, or other managed care operations preferred.
  • Health plan, payer, PBM, or managed care experience preferred.
  • Experience with Epic Tapestry or comparable payer technology preferred.
  • Working knowledge of health plan concepts including benefits, claims, authorizations, medical necessity, and pharmacy benefits.
  • Ability to translate clinical and operational needs into technical requirements and communicate effectively between clinical, operational, and IT teams.

1. Bachelor’s degree in Computer Science, Information Technology or a related field OR two (2) years of relevant experience.

2. Relevant certifications and/or proficiencies may be required for this position, with a target completion within 90 days following formal training provided by WVUHS Information Technology.

1. Experience in applicable business, clinical, imaging, or web application systems, including advanced workflows, focused on driving efficiency and optimization. 

2. Proficiency in systems administration and providing strategic insights and improvements to business operations. 

3. Experience working in inpatient and outpatient clinical settings, with a focus on improving patient care processes through advanced system implementations. 

4. Understanding of clinical data management and healthcare interoperability standards (HL7, FHIR, DICOM) to ensure seamless data exchange and compliance. 

5. Knowledge in Cloud-based healthcare applications and web services, ensuring secure, scalable, and efficient system architecture supported by this role. 

6. Knowledge of reporting tools, delivering actionable insights and enhancing decision-making processes through comprehensive data analysis and reporting capabilities

• →
  • →Support system configuration, testing, implementation, and optimization for Utilization Management and Pharmacy workflows, including prior authorization, medical necessity review, and clinical determinations.
  • →Serve as an IT liaison to UM, Pharmacy, Medical Management, and other clinical health plan teams.
  • →Translate clinical and operational requirements into system requirements, workflows, and testing scenarios.
  • →Support Epic Tapestry and integrated vendor solutions related to medical and pharmacy management.
  • →Support clinical workflows associated with prior authorization, appeals and grievances, pharmacy management, and utilization review.
  • →Assist with implementation of applicable CMS, NCQA, Medicare Advantage, D-SNP, ACA, and other payer regulatory requirements.
  • →Participate in end-to-end testing and issue resolution across authorization, benefits, claims, pharmacy, and related clinical workflows.
  • →Identify opportunities to improve and automate clinical health plan workflows through technology.

• Demonstrates growing commitment to expanding technical knowledge.

• Utilizes resources such as application community sites, professional networks, and industry tools.

• Applies new skills to support tasks and contribute to team objectives.

• Attends basic training sessions and workshops.

• Follows industry news and monitors basic trends.

• Identifies key areas for personal and professional improvement.

• Participates in team discussions and knowledge-sharing activities.

• Conducts basic research for projects and contributes to content development.

• Accepts and incorporates feedback from peers and supervisors.

• Shares knowledge informally with peers.

• Collaborates with other teams to gain a better understanding of their processes.

This position provides specialized clinical and health plan expertise within the Systems Analyst function, supporting Utilization Management (UM), Pharmacy, and related payer workflows. The role serves as a liaison between IT and clinical/operational teams to translate medical, pharmacy, and regulatory requirements into effective system solutions.

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.