Managed Care Analyst III
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.
- 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.
Phoenix Children's Mission, Vision, & Values
To advance hope, healing and the best healthcare for children and their familiesVision
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by:
- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable