Highmark Health
General Overview:
This job works closely with clinical and business leaders to drive trending and operational analytics for population identification, program need, and emerging risk. Uses subject matter expertise and data/analytics to support identifying improvement and savings opportunities for clinical initiatives and has experience using large datasets to perform descriptive and statistical analysis. Possesses a working knowledge that includes but is not limited to: Quality metrics including HEDIS/STARS, Milliman, episodic treatment grouper methodologies, measure performance, Population Health, including population segmentation, risk stratification models, disease management and case management performance tracking and analytics. This role will formally coach and mentor junior team members.
Essential Job Functions:
Develop and foster internal relationships across the corporation. Provide analytic and consultative support to a broad spectrum of internal customer areas and external business partners.
Mentor colleagues with less experience on both the technical and business aspects of project and consultative work.
Determine how decision support systems will provide information required to make effective business decisions, translate requirements into applications that employ appropriate decision support and reporting tools. Use broad experience and technical knowledge to propose solutions to complex business problems. Take the lead in driving the implementation of the recommended solutions.
Take the lead in defining issues and ideas to be studied as well as the approach (methodological and technical) to be used in addressing studies and projects. Create and/or develop new methods of analysis, database design and performance measurement or, in some cases, adaptation of existing solutions to new areas.
Perform modeling of data sources and flows, work with data management staff to define an operational framework that will define, develop and implement policies and security frameworks to ensure precise and secure deliver of knowledge and information.
Provide assistance and, depending on skill and experience, lead with interpretation of raw data, statistical results or otherwise compiled information, identify follow-up action items and prepare or assist in the preparation of written reports and/or oral presentation of findings to internal and external audiences, customer managers, clinical staff, compliance agencies, group accounts, providers, agent plans, and brokers.
Develop and maintain moderate-to extremely-complex computer programs using 4GL programming languages (such as SAS, R, SQL) and other database technology (DB2, Teradata, and Oracle).
Other duties as assigned or requested.
Minimum Qualifications:
Bachelor's Degree in Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering, Operations Research, or related field
7 years of relevant, progressive experience in the area of specialization, including experience in leading projects of varying size and complexity. Grandfathered experience requirement effective August 2016
Preferred Qualifications:
Master's Degree in Computer/Information Science, Mathematics/Statistics, Economics, Industrial Engineering, Operations Research, or related field
Experience and demonstrated proficiency as a Decision Support Analyst or equivalent training and experience in a business or clinical environment with direct responsibility for applying technology
Possesses a working knowledge that includes but is not limited to: Quality metrics including HEDIS/STARS, Milliman, episodic treatment grouper methodologies, measure performance, Population Health, including population segmentation, risk stratification models, disease management and case management performance tracking and analytics.
Advanced degree in quantitative science, epidemiology, biostatistics, health informatics, nursing, pharmacy, or medical sciences.
Experience and demonstrated expertise in data extraction and analytic programming languages (SAS, SQL, R) and data visualization tools.
Knowledge, Skills, and Abilities:
Strong technical skills in the mainframe, PC and Internet-based technologies to be effective and must be comfortable and proficient using large and complex databases
Strong skills using various third-party office and report generation products such as Microsoft Office, Business Objects, Cognos, and Enterprise Guide.
Strong communication skills. Must be comfortable presenting findings and offering recommendations to senior management
Referral Bonus: Level 3
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