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Position Details

Department: Managed Care Contracting
Category: Managed Care
Location: Phoenix
Posting #: 438156
Date Posted: 2/13/2019
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. Predictive Modeling
    • 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.
  2. Data Analytics
    • 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.
  3. Projects 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.
  4. Cross-team Functionality
    • 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.
  5. Analytical Tools
    • 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.
  6. Communication
    • 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.
  7. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. BS or BA in Healthcare or Economics, Mathematics, Finance, Statistics, Actuarial Science, or another business-related field of study or 3 years of experience in managed care contract analytics, contracting, and/or consulting in a healthcare field. Required
Do you meet this requirement?
Experience
1. Comprehensive knowledge of healthcare managed care principles. Required
2. Proficient in Microsoft Excel, Access, Word, Outlook, Powerpoint and Internet. Required
3. 5 or more years of experience in healthcare analytics, revenue cycle management, or related healthcare field. Preferred
4. Experience with state and federal programs such as Medicaid. Preferred
5. Proficiency with contract modeling and visualization tools such as EPSI, Optum II, SAS Visual Analytics, Power BI, or similar. Preferred
Do you meet this requirement?
Special Skills
1. Strong analytical, mathematical, and project management skills. Required
2. Excellent written and oral (presentation) skills. Required
3. Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands. Required
4. Ability to prioritize and handle multiple tasks in a demanding work environment. Required
5. Demonstrated organizational skills. Required
6. Ability to work effectively under deadlines and produce accurate work. Required
7. Ability to communicate complex issues effectively. Required
8. Maintain confidentiality and privacy. Required
9. Must have a strong understanding of health care delivery systems, specifically commercial and government-sponsored programs, such as Medicaid. Understand healthcare markets, advanced financial skills, Health & Benefit products, and services. Required
10. Demonstrated ability to drive results and take initiative. Required
11. Strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, reimbursements mechanisms, billing principles, and practice management/medical office procedures. Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Occasionally
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Frequently
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Frequently
11. Physical Requirement - Walking Frequently
12. Physical Requirement - Near Vision Constantly
13. Physical Requirement - Far Vision Frequently
14. Physical Requirement - Color Discrimination Occasionally
15. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
16. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
17. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply