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Clinical Program Development C...


Job Summary

Chicago, IL
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Clinical Program Development Consultant - AIM Chicago - PS4750

About the Job


This position is located at AIM's corporate office in Chicago, IL (near O'Hare Airport)

Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating access to greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

The Clinical Programs Development Consultant is responsible for providing support and clinical knowledge for all clinical programs and solutions. Develops and creates workflows applicable to new and existing clinical programs and is an integral part of clinical informatics team.

Primary duties may include, but are not limited to:

  • Using clinical background and knowledge of specific Guidelines and Medical Policies, will ensure that the product design adheres to this content by performing clinical QA
  • Develops and modifies clinical programs, tools, and processes
  • Works with IT developers to make sure they understand the business request for new and current products
  • Works with a team of MDs and coders on correct design, usable design, and AMA standards
  • Identifies system needs to implement clinical programs
  • Tracks program performance and results

Other duties include:

  • Use of a clinical authoring tool to collaboratively codify clinical rules and implement evidence-based workflows
  • Performs clinical QA of the pathways and workflow designs to ensure that clinical intent of the Guidelines and Medical policies is reflected accurately in the operational workflow
  • Use additional tools and technologies (business rules engine, enterprise content management, and terminology management) to support workflow
  • Provide subject matter expertise to assist with integration of related processes
  • Provide on-going technical and clinical expertise to assure the consistent delivery of clinical knowledge and clinical decision support
  • Apply clinical information technology and clinical process improvement to support best clinical practices and standardization of care
  • Use and help meet deadlines in the software development life cycle methodology
  • Participate in and/or lead testing of clinical rules-clinical QA, UI, and acceptance testing
  • Work closely with key stakeholders to ensure appropriate changes in workflow
  • May assist in development of training materials for call center staff

About AIM Specialty Health

AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation's leading health benefits companies.

AIM provides innovative clinical solutions that focus on today's most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.

With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.

Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform.

Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL, as well as Glendale, CA.

To learn more, visit www.aimspecialtyhealth.com


The qualified candidate will have:

  • Requires a BA in business, public health, nursing, epidemiology biostatistics or related field
  • RN, BSN, APN, NP, or PA strongly preferred
  • 3 years of experience involving analyses of health care data and clinical program development
  • or any combination of education and experience, which would provide an equivalent background
  • Masters in public health, health services administration, nursing, or business administration preferred
  • Clinical Informatics background preferred with experience using or coding EMRs, lab systems, billing systems, etc.
  • Detailed minded
  • Testing/QA background in software implementations preferred
  • Contact/call center experience preferred
  • Familiarity with clinical decision support or managed care desirable but not required
  • Familiarity with Medical Terminology
  • Must have knowledge of and have used Microsoft Word, Excel, and Visio
  • Ability to manage multiple projects simultaneously
  • Team player
  • Listens well and influences decisions through written and verbal communication
  • Comply with corporate and departmental policies and procedures
  • Ability to adhere to AIM's code of conduct
  • Nursing Informatics certification is highly preferred
  • Additional knowledge in Genetic testing is desirable.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


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