Managed Care Analytics
(Employee must work on site)
Serve as the SME for this medical management area.
**** This is not an IT or Data heavy role – need the expert clinical knowledge.
Must Have great rounded knowledge Managed Care and Clinical knowledge
- Perform and lead various analysis and interpretation to link business needs and objectives and implement process improvements.
- Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems.
- Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
- Resolve issues and identify opportunities for process redesign and improvement
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements.
- Evaluate risks and concerns and communicate to management.
- Coordinate with various business units and departments in the development and delivery of training programs.
- Develop, share, and incorporate organizational best practices into business applications.
- Oversee all changes to departmental policies and procedures, including communicating and implementing the changes.
- Serve as the SME on the assigned function product to ensure operational performance.
(UM, Prior Authorization, Claims, Billing, Coding, G&A, HEDIS)
6+ years of business process or data analysis preferably in healthcare or five plus years of HEDIS
SQL experience is a must (but 2nd to Clinical and Managed care)
Bachelor’s degree in related field or equivalent experience.
Advanced knowledge of Microsoft Applications, including Excel and Access preferred and