The Managed Care Analyst III develops contract models for managed care contracts (including fee for service, value based, and P4P methodologies), creates and maintains ad hoc reporting on healthcare utilization and quality, and supports contract negotiation through consistent and thoughtful data analysis. Modeling and analytics include gathering data from multiple data sources, evaluating and synchronizing resulting data, benchmarking key financial and quality indicators, adjusting for market conditions and strategic objectives, checking for reasonableness using independent judgment, and interpretation of various types of health care data including claims data, encounter data and financial reports. The Managed Care Analyst III presents model results and communicates internally and externally to develop and implement contracts and to support ongoing Managed Care strategies.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- Independently and with input from senior staff summarizes, analyzes and creates predictive models of health care financial and quality data to be used for negotiations/contracting and strategic enterprise-wide initiatives. Such processes should be created using industry standards along with a strong sense of self-interpretation and validation through other data sources.
- Proactively identifies data anomalies and exceptions as observed in summarized health care data; independently benchmarks data from different sources to determine market indicators for financial and quality metrics; develops core department deliverables and ad-hoc analysis. Understands the reasons and impacts of data anomalies, exceptions, and changes in benchmarks on desired analytics in order to explain these issues to senior staff or project lead.
- Serves as a project lead on small to midsized department projects. Coordinates project efforts. Volunteers and promotes active leadership. Provides appropriate written and verbal communication as project lead to team members, manager and customers regarding project status, issue identification and resolution, and analytical results.
- Consults internal teams and external stakeholders to understand objectives, decision-making processes and need for analysis/interpretation of information to ensure information provided is aligned with needs.
- Leverages desktop analytical and report publishing tools, specifically members of the Microsoft Office Suite of products, EPSI contract modeling software, Power BI, and SAS Analytics Pro/Enterprise Guide to improve efficiency and facilitate decision making.
- Participates in meetings with health plans and internal teams to define the scope of the project. Provides insight and expertise on defining the data analysis, including knowledge of the capabilities and flexibility of different approaches. Takes detailed notes to ensure accurate information is collected to determine project and data scope.
- Performs miscellaneous job related duties as requested.