Description
QUALIFICATIONS:
Bachelors degree in healthcare, mathematics, economics, health administration or similar field of study is required. MBA, Master of Science in Medical Informatics, or another related advanced degree is also required. Four years of related experience with demonstrated expertise in epidemiology, biostatistics and/or health service research methodologies and statistical analysis may be accepted in lieu advanced degree. A doctoral level degree in a similar field or area of study is preferred.
Five years of experience in health informatics, health economics, biostatics, actuarial/underwriting, healthcare finance, or other related health plan reporting and analytics role is required. Experience in epidemiology is strongly preferred.
Must have advanced skills using statistical methods such as linear, logistic, and polynomial regression, survival analysis, cluster analysis, time series analysis, factor analysis and other methodologies.
Must have proficiency with commonly used database, spreadsheet, and word processing software (i.e. MS Access, MS Excel, MS Word). Proficiency in a common statistical analysis software package required. SAS is preferred.
Must have demonstrated work experience that shows excellent analytical skills, timely and accurate data maintenance, and excellent quality driven methods to produce information used for reporting and/or decision-making by senior management, the Board of Directors or a similar audience.
Knowledge of managed care processes and provider operations and procedures required.
Knowledge and understanding of medical coding, including grouper-derived codes (i.e. DRG, ETG, DCG) and coding-based risk scoring required.
Experience with evaluating and reporting care management outcomes is required.
ACCOUNTABILITIES:
Performs scientific and technical planning, analysis, reporting and methodological leadership related to provider profiling, medical management outcomes and/or provider reimbursement, network administration, case management, utilization management, disease management, and/or medical policy initiatives in order to provide information to be used for decision making.
Leads the creation, evaluation and selection of predictive modeling, risk scoring and statistical adjustment methodologies and effectively communicates recommendations and rationales to provide meaningful analysis to assist in problem solving, solution development, decision making, and strategic planning.
Participates and assists in the development of client reports as they relate to predictive modeling, risk and case mix adjustment by preparing and providing decision support overviews, demonstrations, and presentations to a wide variety of internal and external audiences.
Serves as technical expert advisor and consultant to collaborating departments on corporate and cross-functional projects, reports, and activities.
Performs peer data quality reviews, validating data and process to ensure accuracy, completeness, and consistency of department output, recommends process improvements as necessary, and investigates existing national and regional data, and performs descriptive and analytic studies using statistical techniques.
This position reports to the Vice President, Healthcare Informatics and Measurement.
We reserve the right to fill this position at a higher or lower level. Grade: 18.
Details:
Job Id:
22734454
Posted / Updated:
5/18/2012 6:13:31 AM
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