Medical Management Data & Reporting Specialist

Medical management data & Report Specialist ensures the accuracy, consistency, and integrity of Utilization Management records and reports, supporting high‑quality operations and data‑driven decision‑making within the Medical Management department. The role provides essential reporting and documentation support to the Vice President, Directors, and Managers, ensuring all materials are prepared, maintained, and coordinated professionally. Also partners closely with internal IT teams to evaluate system performance. Core responsibilities include quality assurance, project management, and process monitoring. Responsibilities Ensure effective reporting capabilities for the Medical Management team by collaborating with department leaders, the Medical Affairs reporting team, and the Informatics Department to support accurate, timely, and comprehensive data reporting. Collaborate with Corporate IT and EPIS to develop and maintain reliable system solutions that align with platform and design requirements while accurately representing the operational needs of the Medical Management department. Facilitates the scheduling of ongoing inservice sessions for Medical Management staff to review new or updated system changes, as well as required CMS and DOH policy updates, ensuring alignment with departmental responsibilities and the health plan's overall goals. Investigate reported application issues to determine root causes, assess system behavior, and evaluate the impact across workflows and operations. Conduct thorough problem and impact analyses, recommending timely, effective, and practical workarounds that support continuity of business operations. Contribute to the development and refinement of departmental workflows that support Medical Management responsibilities and advance the overall goals of the health plan. Develop and maintain Medical Management Key Performance Indicators (KPIs) to support effective monitoring, performance evaluation, and continuous improvement across departmental functions. Manages projects assigned by the Vice President of Medical Management, ensuring all activities adhere to Elderplan's established project management methodology, standards, and timelines. Collaborate with the Medical Management Vice President to enhance and support departmental reporting capabilities. Qualifications Baccalaureate degree in business, computer science, or other information related field or equivalent experience. Minimum of two (2) years of working in care management experience required. Managed Care experience preferred. Excellent analytical skills, interpretation of data. SQL, or Structured Query Language. Microsoft Excel, Access. #J-18808-Ljbffr