Job Description Focuses on the use of information and analytics to improve health and optimize consumer focused business processes. Responsible for the extraction and analysis of health care information regarding network utilization and cost containment and clinical quality information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings to drive the decision-making process and support business operations for internal and external customers in an effort to control medical cost and improve the quality of services provided to members. Performs research and analysis of complex healthcare and/or clinical data regarding network utilization, cost containment and quality improvement information. Responsible for research using multiple sources of data and analyzing algorithms to determine health care expenditures and utilization patterns. Combines complex IT capabilities with advanced clinical knowledge to determine trends, cost/benefit ratios, and forecasting of health care costs, medical management, and health economics. May also be responsible for designing and implementing the systems and programming to analyze and report findings. This position requires a high level of expertise in both analyzing medical data and information systems. May provide guidance or expertise to less experienced analysts. Typically requires Bachelors in Statistics, Mathematics, Epidemiology or equivalent training and mastery; minimum 4 years experience in related health care analytics; or any combination of education and experience, which would provide an equivalent background..
This position includes working with the Physician Profiling Team and matrix partners to support the development, implementation, and ongoing deliverables for Medical Homes. The role includes supporting the intake process for Medical Homes, the ongoing monthly and semiannual report deliverables, and the design and development of Medical Home Reports. All of this requires working collaboratively with our business partners in Quality, Contracting and Product. Strong analytical skills are required to design and develop Medical Home reports. These include identifying data elements, writing business requirements and business specifications, performing analysis, and testing. Physician performance measures include quality indicators, clinical and financial outcomes, and utilization / efficiency measures. The goal will be to implement several new Medical Homes, provide ongoing support to existing Medical Homes, and continue to develop an automated suite of Medical Home reports and tools that will identify practice pattern opportunities relative to utilization, quality, efficiency and financial and clinical outcomes.
- Implement several new Medical Homes. Identify and document business requirements, business specifications, timing, and deliverables with business partners. Work with the team to set up new Medical Homes.
- Provide ongoing support to Medical Homes including monthly and semi annual reports and adhoc queries.
- Perform data analysis on Medical Home results.
- Participate in cross-functional team (Quality, Contracting, Product, IT) to support Medical Homes including future enhancements and automation.
- Write the business requirements and specifications for new Medical Home reports, perform testing.
- Work with the team to continue to review and refine our Medical Home process to ensure it¿s scalable, efficient, and will meet the business need both from a business and technical perspective.
- Participate/coordinate team meetings, work with the team to identify process/quality improvements.
Critical Success Factors:
- Self-starter with an excellent analytical and technical background, experience in application development and systems analysis, as well as project management skills in a matrix organization.
- Works productively in a time sensitive environment that requires constant development of data understanding and data analysis. Proficient at Microsoft Office.
- Ability to understand the business objectives and technology as well as underlying data required to support product needs.
- Demonstrated ability to work at both the conceptual and very detailed levels and easily shifts between the two.
- Excellent communication skills amongst both team members and upper Medical Management Executives and experience working in an empowered team environment.
- Identifies ways to efficiently improve the collection of data, reduce operational costs, always focusing on results.
- Takes quick, decisive, informed action on issues or problems judged as critical.
- Excellent interpersonal and customer service skills, with demonstrated ability to influence internal and external resources.
- Bachelor degree in Business, Mathematics, Finance, Economics, Healthcare, Statistics or related field. Experience analyzing healthcare data in a clinical health care setting a plus.
- 5 plus years experience in health care/managed care with direct responsibility for provider profiling, medical analysis, project management.
- Excellent communication skills to include both written, oral and group presentation skills.
- In-depth understanding of managed care business processes, data (ETG, EBM, ICD9, CPT4, DRG, etc), systems, case-mix adjustment, and applications for claims payment, providers, and utilization management.
- Proven quantitative and analytical skills.
- Strong project management skills and comfort in ability to create and achieve success in highly matrix management environment.
CIGNA - 17 months ago
With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...