Manager Healthcare Data Analytics - 000977 at Excellus Health Plan Inc.

Posted in General Business 9 days ago.

Type: Full-Time
Location: binghamton, New York





Job Description:

The manager is responsible for input and the timely implementation of the Healthcare Data Analytics team strategic work plan. In addition, this individual directs the activities of the team to meet the goals and objectives of the organization. The incumbent builds relationships with health plan partners to deliver meaningful insights and actions with data for program development and to monitor program interventions for effectiveness of the programs including impact on trend. The manager is accountable for developing excellent partner relationships through communication and cooperative interaction with other Health Plan departments they support for clinical, financial, and technical analytic needs.

The manager is also accountable for problem solving and continuous improvement of department operations. The incumbent is accountable for functional strategic oversight to evolve monitoring claim activity with relation to our Utilization and Case Management (UM/CM) suite of programs to report out on effectiveness of current clinical programs and mining claims data to find points of clinical variation and ultimately program development opportunities. This includes acting as a mentor and overseeing the professional growth of lead(s) under supervision, as well as staff under lead roles.

Essential Accountabilities:

• Responsible for development of Healthcare Data Analysts. Handles all staff assessments, including but not limited to performance appraisals and oversight/guidance of individual development plans.

• Drives development of Health Plan scorecard/dashboards with visuals for high level understanding of members cost/use as it relates to trend and benchmarks, providing anchor data for specific line of business reporting; as well as coordinated developing of program specifics (e.g. Utilization Management, Member Care Management, etc.), monitoring data that is easily understood by business leads/external customers with specific focus on buy up programs for our Claims Based Billed groups.

• Manages senior analysts to drive data mining with appropriate parameters (e.g. by line of business, by provider, by clinical classification groupings or health cost groupings) to find areas of impactful variations.

• Understands all Clinical Management Programs (inclusive of but not limited to the scope of Utilization Management, Member Care Management, Behavioral Health, etc.) and how programs are both implemented and executed on our systems and flow through to claims payment (e.g. prior authorization claim to authorization match prior to payment).

• Ensures that team understands the Health Plan Utilization Management programs including but not limited to prior authorization code sets, partner (vendor) program code sets, corporate medical policies and other governing code sets (e.g. CMS, NYSDOH, etc.) to monitor claims data impacts to help quantify UM/CM program effectiveness and value.

• Helps to drive and guide analysts to recommend clinical management intervention strategies based on data for cost, utilization, and industry trends.

• Manages the analytical needs of the organization regarding medical and pharmacy claims, case and disease management, as well as clinical utilization trends and patterns.

• Collaborates with other functional areas to optimize clinical initiatives and to control healthcare expenditures.

• Participates in and supports a cross-functional ideation process through partnership with program development and clinical leadership, leveraging data and technology, competitive intelligence, clinical expertise, and consumer demand to make recommendations in support of the affordability process.

• Assists analysts in synthesizing complex data and information into actionable results and makes recommendations from evaluation of numerous data sources to answer a wide range of organizational needs.

• Assists in the development of the department strategies and goals.

• Collaborates with internal and external business partners to develop innovative analytics and visualizations to drive insights to action, including IT, DMI, Data Science and BI Solutions.

• Directs the activities of the various teams within Healthcare Data Analytics Department to meet the goals and objectives of the organization.

• Tracks departmental effort, status and managing priorities of customers.

• Identifies and manages issues around data structure, data integrity and data definitions. Ensures all appropriate data definitions and instructions are documented for consistency (e.g. membership definitions, etc.).

• Drives appropriate tool use for analysis at hand (i.e. BI tools vs. SAS).

• Ensures that staff follows the Health Plan code of conduct.

• Responsible for the application of process improvement tools and techniques and assists staff in the identification and improvement of opportunities, both within the department and those that are inter-departmental.

• Mentors staff to develop to full potential. Leads by example.

• Directs involvement and responsibility for any and all Human Resources actions, including but not limited to hiring, evaluation and performance management and disciplinary action.

• Works with all levels of management and staff, be familiar with current developments in insurance and health care, provides leadership for change, and monitors tasks, priorities and customer commitments.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.

• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

• Regular and reliable attendance is expected and required.

• Performs other functions as assigned by management.

Minimum Qualifications:

• Bachelor's Degree in business, statistics, math, computer science or health related field. Master's preferred.

• Minimum of seven years of progressive experience in health care, health insurance, or a related quantitative technical field.

• Minimum of 2 years prior experience supervising or managing people and/or projects or indirectly leading teams.

• Ability in using medical claims, prescription drug claims and membership information to analyze the delivery of services under both traditional indemnity and managed care, (ideally on Health Plan data and systems, but outside experience would be acceptable for an otherwise very well qualified candidate).

• Excellent organizational, project management and delegation skills.

• Embraces and leads change, consistently demonstrates problem solving techniques, leadership skills appropriate to a team environment, principles of total quality management, etc.

• Excellent analytic, communication, and presentation skills in both verbal and written format; capable of publication quality work.

• Interacts well with staff and all levels of management and elicits cooperation from other areas in Health Plan.

• Demonstrates tact and excellent listening/interpersonal skills, capable of providing constructive feedback, motivational leadership, coaching and mentoring of professional staff.

• Is receptive to other points of view and alternative approaches; values and capitalizes on the diversity and contributions of others.

• Must be knowledgeable in the use of multiple tools available to run reports including by not limited to SAS, SQL, Cognos, Impromptu and others.

Physical Requirements:

• Must have ability to travel as needed.

************

One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer





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