Medication Use & Management Analyst

Job Description

Job Description

Responsibilities

The Analyst for Medication Use and Management is responsible for the collection and analytics for clinical medication and medication related data, from our EPIC EMR, MedWise, PBM, medical claims and finance data, to support interventions related to participant medication use, optimization and regulatory compliance. Works closely with the Clinical Analytics team on related initiatives.

 

Essential Functions and Work Responsibilities

 

Functional Category: Medication Use

Estimated Percent of time Spent – 85%

• Analyzes pharmacy medication claims data for potential fraud waste and abuse including overcharges, over dispensing and wasteful utilization
• Synthesizes several data sources to report clinical quality and performance metrics in an accurate and timely manner to appropriate organizational senior leadership. Data sources include, but are not limited to: EPIC EMR, MedWise, PBM, medical claims and finance data.
• Develops and executes data analyses to support clinical quality improvement, care management, utilization management in collaboration with clinical leadership.
• Supports Clinical Leadership’s CVI and medication use initiatives with data accumulation, consolidation for performance tracking, intervention targeting and improvement
• Performs concurrent review and retrospective in-depth analysis of patient records and medication claims data for purposes of identifying quality improvement opportunities.
• Develops, maintains and improves a key performance indicators (KPI) data dashboard for use by senior management to track and trend organization-wide performance.

 

Functional Category: Healthcare Coordination

Estimated Percent of time Spent – 15%

• Generates data analyses and reports for presentation to select audiences; including company senior leadership, clinical and quality staff. Possesses strong presentation skills; presenting results orally, in writing and visually for review by both subject matter experts as well as lay people.
• Serves as the organization-wide content expert across all lines of business, for measurement and analysis methods. Imparts knowledge of methods for data collection, implications for research and opportunities for data-driven improvements to senior leaders and quality staff. Continually expands and updates this knowledge.
• Interacts frequently with clinical leadership and quality personnel, including Risk Management, Compliance, Clinical staff, etc. Facilitates discussions with these stakeholders of existing data, reports, and analyses while assessing unmet needs and potential enhancements. Advises on trends and helps coordinate project teams to improve processes.
• Additional collaborations with Information Technology (IT) Data Analytics and Clinical Application departments for reporting development.

Travel Requirements

 

Travel

• Travel may be required
• Overnight travel may include local or out of state

Relocation

• Remote position

Qualifications

 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

 

REQUIRED

• Bachelor's degree in research, statistics, health administration, or a related field from an accredited college or university, or equivalent work experience. 
• Minimum of 3 years of experience with data analysis. Experience with a health plan or PBM is preferred. 
• Minimum of 3 years of experience with generating and ensuring accurate and easily understood data analyses and presenting results orally, in written form or graphical format for review by both subject matter experts as well as lay people. 
• Working knowledge of healthcare industry medication quality measures, clinical performance, and financials measures. 
• Experience with obtaining and manipulating health care data such as: medication claims, clinical values etc.

PREFERRED

 

Work Experience and Qualifications 

• Working experience with EPIC slicer/dicer and Clarity data program.
• Mastery of desktop applications, including MS Office (Teams, Word, Excel and PowerPoint).
• Advanced skills using Tableau, Excel, SQL and other databases. Skills required include, but are not limited to; construction and use of pivot tables, use of advanced formulas and use of VBA and Macros.
• Able to establish and maintain cooperative and positive working relationships.
• Organized, detail-oriented, diplomatic, proactive, self-motivated, dependable, and driven by excellence.
• Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
• Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.