Senior Data Analyst, Healthcare Payer Side, Clinical Programs - Full Time, Direct Only

Remote opportunity for Permanent Residents Only

The Senior Data Analyst, Clinical Programs will be an analytically driven team player, responsible for understanding business needs and objectives, eliciting requirements from stakeholders, and analyzing data and processes to identify opportunities for improvement. This role will support Clinical Programs, Utilization Management, Complex Case Management, and Population Health Management. In this role, you will be challenged to think creatively while developing actionable insights to inform client and program strategy.

Primary Responsibilities

• Monitor Utilization Management and Case Management activities through the development of KPIs and benchmarks (i.e. member engagement rates, readmissions, preventable hospitalizations, ER utilization)
• Develop statistical models that deliver meaningful insights on cost, utilization and clinical outcomes based on various data sources
• Develop algorithms for stratifying populations and identifying high-risk members
• Leverage Predictive Analytics to measure the performance (ROI) of Disease Management and other Medical Management programs
• Conduct prospective savings analyses in support of clinical program initiatives
• Build and maintain client-facing reports, dashboards, and analyses
• Develop actionable data insights and advise on client strategy
• Participate in program performance review presentations with clinical program managers, client account managers, and external clients, as needed
• Manage internal and external client requests and timelines to ensure timely delivery
• Collaborate with Medical Management to provide ongoing support
  
  

Essential Qualifications

• Bachelors' degree required, preferably in Mathematics, Statistics, Finance, Actuarial Science, Data Science, or related field
• 5-7 years of experience in healthcare analytics, preferably in a managed care setting
• Proficiency in SQL and Microsoft SQL Server Suite of Products (SSMS) required
• Proficiency in MS Excel required
• Advanced data analysis, financial modeling, and predictive analytics skills
• Experience with clinical program evaluation and outcomes reporting.
• Experience with health plan performance reporting and cost and utilization analysis
• Experience with developing client-facing reports
• Experience with Business Intelligence applications and DAX functions (PowerPivot, Power BI, Tableau)
• Ability to explain technical concepts to a non-technical audience
• Ability to effectively manage and prioritize several concurrent projects
• Excellent oral and written communications skills
• Experience with Payer Care Management platforms (i.e. ZeOmega) a plus