Manager, Clinical & Business Insight

Role Description

This role manages healthcare data reporting, querying, and analysis for the Data Management department with direct responsibility for healthcare utilization and cost analysis. Oversees a team of Clinical Analysts and Business Intelligence Analysts tasked with providing TriWest leadership with insights from clinical, operational, and performance data. Monitors performance on healthcare discounts and identifies opportunities to improve. Evaluates utilization patterns and develops analysis with recommendations to optimize network to better complement the Government healthcare system and help TriWest meet goals related to access to care and discount targets. Supports strategic initiatives related to healthcare cost management performance objectives and contractual reporting. Drives the organization towards data-driven decision making.

Qualifications

• Bachelor's degree in Business Administration, Healthcare, Statistics, Information Management, CIS or related field or equivalent experience
• 5+ years of data analysis and reporting experience in the health care or insurance industry
• 3+ years experience leading/managing reporting and analytics teams
• Advanced knowledge of Business Intelligence tools (e.g. Tableau, SSRS)
• Excellent verbal and written communication skills and an ability to synthesize and present results in a clear and concise manner
• Demonstrated proficiency in the use of computer systems, spreadsheet applications, and data analysis software such as SQL query language, MS Excel and MS Access
• Familiar with coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue)
• 3+ years working with medical, pharmacy and ancillary claims data, membership data or other healthcare data
• 3+ years developing clinical measures and analyzing healthcare outcomes
• 1 year of experience with advanced analytics tools (e.g. SAS, SPSS, R)
• Masters degree in Business Administration, Statistics, Public Health or other applicable discipline
• Experience with VA healthcare, military health services system, and private Managed Care programs

Requirements

• Act as an internal consultant to work across key stakeholders to gather data, perform analysis, and provide recommendations and insights to business leaders.
• Utilize coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue) to conduct clinical analysis and facilitate improved health outcomes.
• Execute business reporting functions, metric creation and reports that demonstrably drive operational actions and highlight wins / opportunities.
• Interpret claim data using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining.
• Drive improvements in cost efficiency, quality of clinical care, and effectiveness of clinical programs by performing data analysis to deliver actionable insights that are backed by empirical evidence.
• Develop optimization analysis to determine how well TriWest's network meets the needs of the Government based on authorization/claims patterns, discounts achieved and access to care requirements.
• Collect, compile, and analyze healthcare cost and discount trends, and identify opportunities for improving/maintaining discounts based on utilization patterns.
• Collaborate with others in Data Management and IT to enhance the data warehouse to include translating technical and functional requirements into meaningful information and improve healthcare reporting capability.
• Train department staff on healthcare data querying, terminology, integrity, standards, and procedures.
• Coach and mentor staff toward operational excellence and skill development.
• Work with management to understand and interpret the impact of decisions made by retrieving and analyzing claims costs, authorizations and/or other relevant data.
• Support Government reporting requirements, management and the medical management system by managing automated reports.
• Develop methods for consistency and validity and review the accuracy of data and reports.
• Preparation of annual performance evaluations and development plans for assigned staff.
• Perform other duties as assigned.
• Regular and reliable attendance is required.

Benefits

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time
• Frequent pay raises and overtime opportunities
• Recognition and reward programs
• Salary range: approximately $125,000 - $134,000 per year

Company Description

Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.