Work Location: Work from home
Position Description
As the Health Services Principal Analyst, you will be responsible for leading analytics and reporting regarding population health, case management, disease management, utilization review, and appeals and grievances. You will independently lead critical projects, develop complex health services analysis, collaborate cross-functionally across the organization, and develop and maintain SAS/SQL queries and Tableau reports to support Health Services' goals to improve quality of care for our members and community.
- Lead analysis of population health data to identify trends and patterns that impact the goals of Health Services; including but not limited to developing innovative analytic methods to identify trends and drivers of inpatient utilization, readmission, prior authorizations, social determinants of health, and health risk assessments.
- Design, create and execute new analysis of services or treatments and initiatives that are identified as needing further investigation to identify key utilization metrics and cost drivers, and opportunities for programmatic intervention.
- Develop reports and Tableau dashboards that effectively communicate performance to operational and clinical leaders and stakeholders. Integrate clinical, financial, cost, demographic, billing and other data from various sources when performing analysis and preparing reports and dashboards.
- Serve as the primary team liaison to internal and external customers. Present analytical reports to Health Services leadership in a well-organized and concise manner, which is easily understood and clearly identifies areas of focus.
- Evaluate Health Services programs and initiatives; including but not limited to measuring the effectiveness of disease management and case management programs and identifying areas for improvement.
- Collaborate with UCare’s Health Care Economics Department to extract relevant data required for report creation and effective analysis of key clinical and quality metrics for Health Services.
- Deliver information to support various projects that include, but are not limited to, quality improvement, cost containment, protocol-specific performance monitoring, clinical outcomes analysis, physician resource utilization, delegation oversight and compliance, and market analysis.
- Analyze data to determine effectiveness of logic in identifying “high risk”, "medium risk", "low risk" members for disease management and case management.
- Maintain a thorough understanding of data structure within UCare’s internal data systems, including membership, enrollment, claims, providers, and product lines.
- Develop expertise in the utilization of UCare’s Business Intelligence tools, including Microsoft Office Suite, Microsoft SQL Management Studio, SAS, Tableau, and other reporting software solutions for the purpose of routine and ad hoc reporting.
- Review literature and provide recommendations as requested related to program operations.
- Other projects and duties as assigned.
Education
Bachelor's degree in health sciences research, public health or other field with a strong emphasis on critical thinking and program analysis. Statistic courses required. Master's degree or higher in statistics or health care discipline preferred.
Required Experience
Five years of progressive experience with health care metrics. Must possess a thorough understanding of healthcare data and key concepts in the managed care and disease management industries. Related database experience and experience with statistical and query software (Excel, MS Access, SQL, Tableau).
Preferred Experience
Experience with other major areas of health care analytics (utilization, predictive modeling, program evaluation, etc).
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