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Senior Clinical Outcomes Informatics Analyst at Capital BlueCross

Posted in General Business 30+ days ago.

Type: Full-Time
Location: Harrisburg, Pennsylvania





Job Description:

The Sr. Clinical Outcomes Informatics Analyst supports Medical Affairs in ensuring maximum cost-effectiveness while maintaining quality outcome driven care. Studies and compiles medical data, offering summary to the Utilization Management & Care Management teams. Supports the Department in monitoring reporting/outcomes for timeliness, compliance and program effectiveness, and establishing operational processes. Monitors utilization reports and summarizes findings/trends for the Medical Management team.

Supports the Medical Management team with development and monitoring of operational reporting. Maintains monthly operational reporting and identifies trends/issues. Manages routine and ad hoc reporting of clinical data. Identifies improvement opportunities and best practices.

Supports reporting and monitoring of cost benefit analysis for Medical Management projects, using a variety of techniques. Evaluates outcomes, identifying trends and the need to institute adjustments for project success. Works in collaboration with Medical Management and cross-functionally to represent the team on projects to support reporting development and monitoring.


  • Provide analytical support for new and ongoing clinical projects. Makes recommendations to management to solve complex business issues from a strategic and tactical perspective.

  • Establishes analytical framework and oversees the development of analytical reports required to support clinical innovations activities, including development of methodology.  

  • Analyzes results and uses of data to identify cost and quality improvement opportunities in partnership cross-functional areas.

  • Responsible for creating and monitoring operational reports for the Medical Management team.

  • Provide analysis and input for trends and possible improvements. 

  • Prepares Cost-Benefit Analyses in support of Medical Management initiatives, and presents to internal committees such as Project Management Team and Medical Economics.

  • Supports the development of standard reports, metrics and compliance for Medical Management.  Reports finding to management team. Develops standard reporting packages. 

  • Supports in the development of methodologies for the stratification of patient populations on the basis of cost, risk, and clinical factors for the purposes of administering clinical interventions.

  • Maintains consistency in program initiatives across departments for analysis of practice patterns. Works with other departments, as appropriate, in collaboration with internal & external customers to: analyze opportunities for improvement.  Support establishment of action plans to target opportunities, set market-specific goals and analyze impact of targeted interventions.

  • Remains current on best practices in medical information management. Monitor external information sources including but not limited to health plan information submitted to the Pennsylvania Insurance Department, insurance and health plan publications and clinical studies. 

  • Proactively analyzes data and trends, presents data in support of Medical Management Executive team.

  • Represents Medical Management on workgroups, committees, executive meetings.  Addresses reporting and analytics needs for these activities.

  • Maintains current research on available new or existing business intelligence and clinical intelligence software applications.

  • Supports NCQA, CMS and state UM and care management reporting requirements. 

  • Participates in projects supporting the Medical Management team with reporting needs and trend monitoring.  

  • Works cross-functionally to support reporting for clinical management programs on medical costs and trends.

  • Supports the management teams reporting requirements ad hoc and standard reporting development and maintenance. 

  • Manages business and statistical analysis in support of strategic or operational projects.

  • Prepare monthly status reports.

  • Observe and analyze business process functions throughout the department. Identify, plan and assist with the implementation of improved work flows to increase efficiency and improve outcomes.

  • Create specification requirement documents for reports, outcome measurement tools, and software customizations. 

  • Assists with testing reports, customizations and new software report builds along with other technology updates.

  • Functions as a resource / mentor for Clinical Outcomes Informatics Analysts.

  • Performs other related duties and assignments as directed.

Knowledge:


  • Knowledge of managed care insurance business processes, data, systems and applications for authorization, claim payments, network and provider contract management.

  • Knowledge of NCQA, CMS and state requirements such as DOH. 

Skills:


  • Technical sophistication with relational database concepts and applications, analytic data development (statistics) and decision support tools.

  • Demonstrated strong oral, written and presentation skills. 

  • Demonstrated project management skills.

  • Demonstrated ability to drive results to completion, while managing multiple projects and priorities, including organization skills.

  • Problem solving skills. 

Experience:


  • Minimum of four years with data management systems.

  •  Experience with population-based analysis and background in research methodologies and statistics required.  

  • System experience with; SAS, SQL, Microsoft Outlook, word, excel and power point.  

  • Experience with data visualization software such as Microsoft Power BI or Tableau a plus.  

Education, Certification, and Licenses:

  • Bachelor’s Degree in related field such as computer science, mathematics, statistics, business, finance, economics and/or health administration.

Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. 





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