Position Purpose: Direct the development of analytical processes and data interventions to improve quality performance and identify clinical opportunities and target membership for specific quality and clinical interventions.
Provide leadership and guidance to managers, supervisors and/or professional staff. This includes but is not limited to performance management and succession planning.
Establish and monitor roadmaps to investigate high cost and low quality providers and develop actions plans to lower cost and improve quality.
Perform analysis of financial, healthcare cost and utilization, and quality measures data.
Participate in trend analysis and various committees.
Provide data analysis to the Integrated Care Teams to enhance the identification of high risk members and facilitate care and disease management services.
Participate in Integrated Care Team rounds and provide data analytics insight on clinical opportunities.
Work closely with Finance leadership to analyze rising cost and utilization trends.
Develop and monitor annual operating plan initiatives to lower utilization cost and improve quality.
Develop data validation process to ensure accurate HEDIS and state specific measuresreporting.
Education/Experience: Bachelor's degree in Healthcare Analytics, Math, Statistics or related field. 5+ years’ experience involving plan operation and clinical programs. Previous experience as a lead in a functional area, experience including hiring, training, assigning work and managing the performance of staff. Experience with utilization management metrics and profiling is preferred.