Your Role
The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Medical Informatics, Consultant will report to the Manager of HQA Analytics. In this role you will be responsible for evaluating the financial performance and impact of clinical initiatives within the Medical Care Programs team. This role focuses on analyzing healthcare cost drivers, quantifying savings and outcomes generated by clinical interventions, and providing actionable insights to support cost containment and quality improvement strategies.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
Requires at least 7 years of prior relevant experience
Requires at least 5 years of experience in Health Care (managed care, academic, or gov''t payer)
Requires proficiency in one or more dashboard/BI tools, such as Power BI or Tableau
Requires at least 3 years of data modeling experience, and advanced proficiency in SQL for complex query development, data transformation, and performance optimization across large-scale datasets
Demonstrated financial acumen with a deep understanding of healthcare cost structures, including but not limited to drivers of medical expense such as utilization, unit cost, site of care, and member risk profile. Ability to interpret and analyze cost trends across medical and pharmacy spend and evaluate the financial impact of clinical and operational initiatives to support informed decision-making and cost containment strategies
Experience evaluating and calculating return on investment for clinical program participation, including measuring program costs against realized savings and outcomes to assess financial effectiveness and value highly preferred
Experience working with authorization datasets and medical policies, with strong familiarity in analyzing medical and pharmacy services, including interpretation and application of CPT, HCPCS, ICD, and NDC procedure/code sets, is a plus
Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Your Work
In this role, you will:
Conduct independent analysis of high complexity under minimal supervision and guidance
Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst V, supervisor or manager
Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
Provide training and mentoring for team members on best practices for analysis and
reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower-level analysts and analysts in other Departments
Build and maintain robust data models for cost of savings data, sometimes integrating multiple data sources (e.g., authorization, medical care programs, case management, and claims data) and ensuring alignment with business rules, data quality standards, and reporting requirements
Develop methodologies and data models to calculate baseline vs. realized savings of clinical programs, including avoided costs and trend adjustments. Responsible for providing key performance indicators on clinical programs, particularly surrounding program usage
Your Work
In this role, you will:
Conduct independent analysis of high complexity under minimal supervision and guidance
Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst V, supervisor or manager
Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
Provide training and mentoring for team members on best practices for analysis and
reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower-level analysts and analysts in other Departments
Build and maintain robust data models for cost of savings data, sometimes integrating multiple data sources (e.g., authorization, medical care programs, case management, and claims data) and ensuring alignment with business rules, data quality standards, and reporting requirements
Develop methodologies and data models to calculate baseline vs. realized savings of clinical programs, including avoided costs and trend adjustments. Responsible for providing key performance indicators on clinical programs, particularly surrounding program usage