RN - Clinical Analyst
HealthNow New York Inc. - Buffalo, NY

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Position Summary: The incumbent in this position is responsible for ensuring that quality and cost effective care is delivered to members. The incumbent will assist in containing costs of healthcare services by detecting, resolving and preventing improper utilization of member benefits. This individual demonstrates leadership in coordinating with healthcare services teams, provider services, and with Employer Group Reporting Consultants to optimize care to members and delivery of information to employers. The Consultant will perform and present proactive, ongoing review of targeted health care utilization analyses to identify employer group health care trends, related costs and potential solutions to decrease or control medical expense. This will be accomplished through the comprehensive review of data from Disease Management, Care Management, Case Management, Preventive Screening outcomes, as well as data reported from claims and pharmacy. The focus is on assuring appropriate healthcare services are provided to members of key employer groups as evident through continuous clinical performance reviews.

Primary Job Duties:
  • Implements, analyzes and interprets business and clinical outcomes on multiple populations. Evaluates and validates results. Writes outcomes reports and assists in preparing presentations and summarizing outcomes or related activities in presentations to employer groups
  • Researches and recommends solutions in the form of account action plans to effectively meet member needs based on employer group trends and requirements
  • Ensures healthcare services follow-through with account action plans
  • Establishes, implements and oversees a process to solicit feedback from employer groups relative to their specific programming preferences
  • Makes recommendations into the design of the healthcare services programs based on feedback from the SBUs and clients to maximize client value, trend management and revenue
  • Responsible for quality assurance of report production. Responsible for managing the workflow for employer clinical analytics
  • Performs other related duties as required
Required Skills Primary Skills/Knowledge:
  • Demonstrated leadership and relationship building qualities
  • Clinical expertise of the health needs for the population served
  • Experience in employer/broker relations and understanding of employer needs for managing health care expense and improving health of employees
  • Excellent interpersonal, verbal and written communication skills with experience in developing presentations and public speaking
  • Travel to employer sites when necessary to participate in employer meetings
  • Understanding the importance of maintaining the physical and technical security and privacy of protected health information (PHI)
  • Analytical and problem-solving experience
  • Experience with relational databases and data analysis
  • Experience in the health care/pharmaceutical industry preferred
  • Intermediate experience in MS Word and MS Access
  • Expert experience in MS Excel and MS PPT
Required Experience Education:
  • Bachelors of Science Degree in Nursing, Business Administration, Healthcare Administration, or related field required
  • Masters Degree preferred
Experience: 7-10 years work experience in a healthcare environment/industry required

Working Conditions:
  • Must be able to work in an office environment
  • Must be able to attend off-site meetings, events, conferences
  • Must have ability and access to work from remote location such as home
  • Must be able to accommodate regional travel. (DMV check will be conducted to review candidate's driving record)
  • Must be able to accommodate regional/national travel (auto or air)
  • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
  • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
  • Vision Req: Close vision (clear vision at 20 inches or less)
  • Vision Req: Distance (clear vision at 20 feet or more)
  • Physical Effort: Minimum; typical of most office work, mostly sedentary work
Required Licenses/Certifications:
  • NYS Registered Professional Nurse License required
  • Driver's License/DMV Check required

About this company
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HealthNow New York Inc. is one of New York’s leading health care companies that provide access to quality health care and innovative...