The job will have a broad role in the Organization's transformational journey. The job will be the primary analytical support for the SVP of Clinical Services and the SVP of Provider, Network and Reimbursement. The incumbent leads several analytical teams that cover such analytical domains as design of the reporting and analytical packages to support providers in Pay 4 Value/ Value Based Reimbursement programs, design and innovation of the Organization's risk stratification approaches (including incorporation of new data sources and predictive modeling), analysis of key utilization metrics, and development of new analytics to support network design and management. The incumbent will be accountable for leading and guiding their teams that are consulting with senior business leaders to identify opportunities to build self-service tools, design new reports/ analytics, assess program performance, and conduct other innovative analytics that deliver business value.
Essential Job Functions:
- Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Create and implement the right strategy to ensure that the Organization has an innovative, marketing leading suite of analytic and reporting packages for Primary Care Physicians, Specialists, Hospitals and other Ancillary Providers. These would include incorporation of new data sources (e.g., clinical/ EMR data), predictive modeling, and application of new visualization tools that help providers and their staff turn analytics into action/ impact. This will include leading the team to build these packages and installation of a continuous improvement process/ mindset to ensure the Organization's analytics stay market leading.
- Create and implement the right strategy to ensure that the Organization can build and continuously improve a comprehensive set of risk identification and stratification algorithms that will fuel population health programs driven by internal Organization resources (e.g., nurse managers), Provider partners (e.g., Primary Care Professionals) and/ or clinical resources embedded within providers. This would include guiding and supporting the teams that are continuously searching for new data sources (beyond claims) and continuously testing new analytical techniques to improve the Organization's ability to identify members with rising risks and emerging trends.
- Create the right framework to enable standard assessment of physician performance (across cost, quality and other dimensions) and effectiveness of their referral patterns (e.g., social network analysis) to enable the build and continuous monitoring of custom high efficiency networks. This would include ensuring that the teams continuously integrate new data techniques/ approaches, such as new episode logic and other new care models/ pathway development.
- Represent the Organization and our analytic capabilities with external Provider partners (both Physicians and Executive Leadership) to ensure they deeply understand current capabilities and are able to provide continuous feedback/ input to ensure the capabilities stay market leading.
- Other duties as assigned.
- Bachelor's Degree in Business Administration/Management, Computer Engineering or Actuarial Science
- Master's Degree in Business Administration/Management, Computer Engineering, Mathematics Statistics
- 5 - 7 years of Data Analytics experience
- 5 - 7 years of Management experience
- 5 - 7 years of Healthcare Industry experience
- 1 - 3 years of Predictive Modeling experience
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