SUMMARY: The Senior Healthcare Economics Consultant will be a part of the Decision Support/Healthcare Analytics team providing a broad range of analytical services and support to the Monarch HealthCare organization.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Develop, prepare and present to senior leadership specialized reports, analysis, and complex financial models.
2. Interpret and analyze healthcare data from both internal and external sources.
3. Analyze data and provide solutions/recommendations in response to anticipated/unanticipated fluctuations in the company's business affairs (e.g., risk adjusted, capitated revenue, fee for service expense, utilization).
4. Provide analytical support for Senior Management, Finance, Medical Management and Contracting in medical cost and operations analysis, strategic planning and clinical utilization analysis.
5. Work independently and closely with report requestor to assist in defining strategic solutions that solve business issues and enhance corporate performance. Consultatively suggest appropriate content and create intuitive design/layouts for presentation where appropriate.
6. Initiate and complete statistical studies to document current utilization trends/methodologies. Once completed, must be able to communicate findings to management in a concise, understandable format.
7. Design specifications for statistical comparative data analysis and for individual reports for effective evaluation of various provider contractual arrangements.
8. Translate provider performance analytical requirements into logical, economical and practical systems and report design.
9. Analyze the financial performance of managed care contracts, produce contract performance reports, models reimbursement rates, evaluates financial contract modifications and compiles/monitors key managed care statistics.
10. Analyze, provide recommendations, and if necessary design shared-risk arrangements that optimally align incentives between payers and providers.
11. Auditing and analyzing financial, claims and medical data as directed using internal and external data.
12. Participate in the development and maintenance of performance metrics, measurements, methods, and targets.
13. Assist with identifying performance improvement opportunities.
14. Provide ongoing management consulting on the use and interpretation of analysis, reports, methodologies, systems and source data.
15. Work closely with the Finance managers to improve financial analysis, reporting, budgeting, and forecasting process.
16. Work with outside departments to develop and optimize reporting analytic opportunities.
17. Act as a champion of the data warehouse between DSS and IIS staff to identify and provide data management solutions which ensure consistency and integrity of data.
18. Serve as the analytic representative on key committees.
19. Regular and consistent attendance.
EDUCATION AND/OR EXPERIENCE: Bachelor's degree in Finance, Economics, Accounting or a related field; MBA preferred. 5+ years relevant experience; healthcare/managed care experience required: bed day utilization benchmarks, trends, utilization referral management key metrics, and medical claims payment industry standards. Two to three years of experience measuring and monitoring proposed and actual provider unit cost trend. Two to three years of experience supporting capitated provider contract renewals (from either the health plan or provider point of view). Experience with analytical support on Medicare ACO business a plus.
LANGUAGE SKILLS: Must be able to conceptualize, design and communicate new models and analyses. Excellent communication skills both oral and written; presentation and reporting skills are essential. Ability to read, analyze and interpret documents such as common scientific and technical journals, financial reports and legal documents. Ability to write routine reports and correspondence. Ability to speak effectively before all levels of management and employees of the organization.
MATHEMATICAL SKILLS: Ability to work with and calculate mathematical concepts such as probability and statistical inference. Ability to apply concepts of basic algebra and geometry.
REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
COMPUTER SKILLS: Requires advanced ability with Microsoft Office tools including Word, PowerPoint, Excel and Access. Use of Microsoft tools to effectively query data from large and disparate SQL Server databases. Proven skills in report development.
OTHER SKILLS and ABILITIES: Problem solving, project management and team leadership skills. Strong analytical and problem solving skills are required. Prefer experience in writing complex T-SQL queries. Advanced knowledge of Microsoft Excel and Access. Ability to work effectively in a team environment and independently perform individual tasks within a project. Medical terminology and a clinical background are a plus.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; and reach with hands and arms. The employee frequently is required to talk or hear. The employee is occasionally required to stand and walk.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Monarch HealthCare is proud to be part of OptumHealth!
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Skills / Requirements