+--------------------------------------------------------------------------+ |   | | | | JOB SUMMARY: | | | | The Senior Medical Economics Analyst is a key member of the Finance | | management team and serves as a strategic partner to various functional | | areas throughout the organization to meet corporate objectives. This | | includes the planning, development and building of analytical tools and | | to assess and manage provider performance through Medical Management | | initiatives other key analytical exercises. | | | |   | +--------------------------------------------------------------------------+ | KEY FUNCTIONS/RESPONSIBILITIES: | | | | - Work closely with the Director of Clinical and Payment analytics to | | develop, maintain, and leverage a best in class clinical analytics | | infrastructure to support BMCHP’s Office of Clinical Affairs and the | | Plan’s medical management strategy. | | - Lead the development of critical analytic processes comparing Plan’s | | performance against benchmarks to determine areas of focus and | | opportunity and help maintain industry competitiveness | | and intelligence. Work closely with supervisor to present data and | | findings with insights to the clinical leadership teams to help | | launch performance improvement initiatives. | | - Serve as the key analytics partner for the Clinical team leadership | | to develop program performance metrics and KPI’s to measure the | | performance improvement initiatives. Build and maintain dashboards | | that are critical to fine tuning operations, evaluating performance | | of new initiatives as well as serve as leading indicators of | | medical spend. | | - Build relationship with analytic counterparts at UM vendors and | | build robust processes to measure and validate ROI on vended | | programs, jointly present at JOC and build overall monitoring | | capability to identify new and missed opportunities based on | | utilization and cost trends. | | - Develop analytical processes to measure ROI on internally managed UM | | initiatives and provide insights to leadership on Medical | | management strategy. | | | |   | +--------------------------------------------------------------------------+ | SUPERVISION EXERCISED: | | | | - May provide technical support and content training to less | | experienced staff. | | | |   | +--------------------------------------------------------------------------+ | SUPERVISION RECEIVED: | | | | - Expected to work independently with support from Director and | | colleagues in Provider and Clinical Analytics, Medical Management | | and Contracting. | +--------------------------------------------------------------------------+ | QUALIFICATIONS: | | | |   | | | | EDUCATION: | | | | - Bachelor’s Degree in Finance, Health Care Administration, Public | | Health or related field required.  | | | |   | | | | PREFERRED/DESIRABLE: | | | | - Master’s Degree in a related field preferred. | | | |   | +--------------------------------------------------------------------------+ | EXPERIENCE: | | | | - Five or more years of progressively responsible experience in | | managed care data analysis and reporting is required.   | | - Three or more years conducting advanced analytics using SAS and/or | | SQL.    | | - A background in managed healthcare, insurance operations required. | | | |   | | | | PREFERRED/DESIRABLE: | | | |   | +--------------------------------------------------------------------------+ | CERTIFICATION OR CONDITIONS OF EMPLOYMENT:  | | | | - Pre-employment background check | | | |   | +--------------------------------------------------------------------------+ | COMPETENCIES, SKILLS, AND ATTRIBUTES_:  _ | | | | - Advanced SAS and/or SQL programming skills. Proficient in | | Microsoft Excel. | | - Strong analytical and problem solving abilities. Ability to use all | | relevant data to support decision making.    | | - Enjoy analytical challenges in a fast paced environment with strong | | ability for managing multiple projects simultaneously and | | meeting deadlines.  Project management skills a plus. | | | | - Strong communications skills, both verbal and written, are required. | | | |   | +--------------------------------------------------------------------------+ | WORKING CONDITIONS AND PHYSICAL EFFORT: | | | | - Regular and reliable attendance is an essential function of | | the position. | | - Work is normally performed in a typical interior/office | | work environment. | | - No or very limited physical effort required. No or very limited | | exposure to physical risk. | | | |   | +--------------------------------------------------------------------------+

Required Skills Required Experience