Summary: Responsible for development of sophisticated models, reporting and analytics to drive change in the delivery of health care through collaborative agreements between ConnectiCare and its health care providers. This individual will be responsible for creating the information that will empower both internal and provider partners to identify areas of opportunity to make meaningful changes to the cost and quality of health care being delivered to ConnectiCare’s members
- Manage the development of state of the art reporting that allows CCI to effectively understand cost of care trend drivers (both retrospectively and prospectively) and implement a communication strategy that allows this information to be effectively distributed to all interested departments.
- Conducts and coordinates cross-functional analysis of health care data to identify trends, explain plan results, and discover opportunities for plan improvement. Communicates findings to senior management and the appropriate stake-holders.
- Design, develop, and implement statistically valid tests for internal and external assumptions for healthcare cost savings. Design methods that take into account the justifiable causes for variation in medical costs (age, sex, illness, severity, etc,) and develop reports that summarize this information in a way that management can use to make actionable decisions.
- Develop standard and adhoc reporting and analysis for provider collaboration agreements that will drive to strong provider relationships, reduced medical costs, enhanced revenue and improved quality outcomes.
- Work with vendor to implement and utilize provider efficiency and quality ranking software to be utilized in provider network, steerage and provider collaboration (e.g., ACO, PCMH) initiatives
- Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations.
- Works with internal stakeholders to determine appropriate information for corrective action management reports. Prepares sophisticated financial analysis of proposed value based contracting initiatives, using raw data to create reports.
- Identifies deficiencies in data quality and works cross-functionally to resolve.
- Performs other related projects and duties as assigned.
- Requires Bachelors Degree in Actuarial Sciences, Decision & Information Sciences, Medical Informatics, Finance or related quantitative field and 5-7 years of experience in the design, development, and management of informational analysis tools. In lieu of a Bachelor’s degree and 5 years of experience as stated, we will accept a Master’s degree in one of the stated fields and 3 years of work experience, and will view one year of Ph.D. studies as equivalent to each year of required work experience as stated on a one to one basis.
- Previous work experience in cost of care and trend analysis required preferably within a managed care environment.
- Must have previous work experience in interpreting financial results and explaining variances from budget to actual.
- Ability to use raw data to create meaningful reports through working knowledge of relational database principles including SQL, SAS, and MS-Office products. Excellent quantitative and analytical skills.
- Excellent quantitative and analytical skills.
- Knowledge of medical terminology and coding methodologies required. HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's required.
- Good oral and written communication skills with work experience in presenting analysis to key stakeholders to support strategic business decisions.
- Good project management skills.
ESSENTIAL JOB REQUIREMENTS:
- Primarily sedentary
- Must be able to use standard office equipment
ConnectiCare is an equal opportunity employer. M/F/D/V
Resource Based Relative Value Scale
Implantable Cardioverter Defibrillator
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