$80K — $100K *
The Clinical Outcomes Informatics Specialist supports Consulting Services and Clinical Innovations in ensuring maximum cost-effectiveness while maintaining quality outcome driven care. Supports the Department in developing clinical program goals and objectives that are data driven which involve the optimum utilization of resources, thereby maintaining high profitability ratio. Responsible for analysis and measurement of quality, utilization and cost drivers as well as short term and long range forecasting and planning for Geneia’s clinical innovations programs. Supports the clinical outreach and engagement programs in data analysis and trending to evaluate program effectiveness and determine areas of focus to support outcome improvement. Manages routine and ad hoc analysis of clinical data. Identifies improvement opportunities and best practices. Provides input into strategy recommendations for program development and policy development.
Collaborates on the development of Clinical initiatives. Development of analytical frameworks to support Consulting Services and Clinical Innovations program implementation and evaluation. This includes support of NCQA accreditation and evaluation of proposed projects and outcome review of implemented projects. Business leader for clinical analysis and presentation to cross-functional areas.
Provide analytical support for new and ongoing clinical projects. Makes recommendations to management to solve complex business issues from a strategic and tactical perspective.
Oversees the development of analytical reports required to support clinical innovations activities. Analyzes results and uses of data to identify cost and quality improvement opportunities in partnership cross-functional areas.
Establishes the framework for maintaining the integrity of information/metrics.
Establishes analytical framework and oversees the development of methods, standard reports and metrics to enable development of action plans and clinical programs in conjunction with partners.
Monitors best practices in medical information management across the region, state and nationally. Monitors 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.
Maintains current research on available new or existing business intelligence and clinical intelligence software applications.
Works with Geneia partners to evaluate and recommend improvements to programs and technology solutions (workflows, analytics, metrics, etc.)
Maintains consistency in program initiatives across departments for analysis of practice patterns. Works with other departments, as appropriate, in collaboration with Geneia customers to: analyze opportunities for improvement. Support establishment of action plans to target opportunities, set market-specific goals and analyze impact of targeted interventions.
Provides input into national (NCQA), CMS and Customer reporting requirements.
Assists in the development of business process models, policies, procedures and training as they relate to systems and reporting.
Manages business and statistical analysis in support of strategic or operational projects.
Participates in projects supporting health care information management and data analytics.
Works cross-functionally to analyze and explain the impact of clinical innovation programs on medical costs and trends.
Supports Clinical Innovations as data analytics leader for presentation of reports and data analysis supporting program and projects for clinical initiatives.
Calculate various health care costs related analysis and present impact analysis to clinical team.
Perform economic analysis and model plans for health-care programs.
Performs other related duties and assignments as directed.
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 etc.
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.
Minimum of eight years’ successful experience in financial/health care cost driver analysis and modeling.
Experience with population-based analysis and background in research methodologies and statistics required.
Minimum requirements include a Bachelor’s Degree in statistics, business, finance, economics and/or health administration.
Valid through: 10/28/2020
$70K — $90K + $80K bonus
$80K — $120K
2 days ago