Health Care

applicants

Position Purpose: Coordinate and manage health economics models and health services outcome studies and will conduct opportunity analysis and outcome reporting for disease management programs and pharmacoeconomics data analysis. Coordinate and prioritize data and analysis requests across health plans and corporate customers. Identify and communicate synergies in information and analysis needs among customers. Knowledge/Experience: Bachelor’s degree in related field. 4-6 years experience in health sciences research or health data analysis. Knowledge of statistics and application of higher level mathematical models in medical and pharmacy claims data. Basic understanding of health insurance business, claims payment procedures, strategies and trends in health care government program. Master’s degree preferred. Position Responsibilities: • Working with Health Plan and Corporate customers, identify and prioritize based on business value, the recurring and ad hoc data, information and analysis needs of the Health Plan to enable them to manage their medical costs and ensure delivery of quality health care to their members. • Coordinate analysis and development initiatives with cross plan initiatives and capabilities. Perform analysis and reporting to support the Health Plan and Corporate. • Support the Medical Management department by examining data integrity, analyzing outside vendors models and establishing pharmacy profiles of high utilization. • Integrate pharmacy and medical data components for products and special programs. • Conduct opportunity analysis on disease management programs and perform health care outcome analysis projects. • Manage the process for changes to Outcomes Analysis Reports and maintain outcome reporting as it related to CQI initiatives. • Manage, analyze and report on clinical, financial and health care outcomes data using analytical software such as Access or SAS and present findings to internal and external customers. • Manage the development efforts, with our technical team liaisons, including business requirements gathering and documentation, testing, delivery and user adoption, effectively communicating deliverable expectations to the Health Plan. • Develop and conduct training programs.