Note: The job is a remote job and is open to candidates in USA. TriWest Healthcare Alliance is dedicated to serving America’s heroes by connecting them to healthcare in the community. The Manager of Clinical & Business Insight will oversee healthcare data reporting, analysis, and a team of analysts to provide insights that enhance operational performance and cost management within the healthcare system.
Responsibilities
- 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. Work closely with various groups in the assembling of data, development and application of quantitative analysis and mathematical models for internal and regulatory reporting requirements
- 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. Determine the best approach for presenting data in an efficient and beneficial manner
- Preparation of annual performance evaluations and development plans for assigned staff
- Perform other duties as assigned
- Regular and reliable attendance is required
Skills
- US Citizenship REQUIRED: Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position
- 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
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
- Overtime opportunities to earn even more
- Recognition and reward programs
Company Overview
TriWest Healthcare Alliance - Serving Those Who Serve. At TriWest, we honor the sacrifice and service of our nations military families by It was founded in 1996, and is headquartered in Phoenix, Arizona, USA, with a workforce of 1001-5000 employees. Its website is http://triwest.com.