Seeking a Manager that will lead identification and acquisition of clinical data to support quality and programmatic reporting needs across enterprise.
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com
- Lead in a matrix organization by effectively maintaining and building relationships across functional teams and business units.
- Lead identification and acquisition of clinical data to support quality and programmatic reporting needs across enterprise, to include collaboration and partnership with other key ACFC departments.
- Lead the maintenance of a comprehensive catalog of clinical data assets respective to the enterprise and line of business.
- Partner with Information Services (IS) and key business stakeholders to align and manage an active Data Governance agenda where data is manipulated to yield actionable information for the purpose of evidence based decision making.
- Ensure as decisions are made, problems are solved that progress is documented e.g., Business applications inventory, data assets cataloged, standard file layouts and standard workflows for HEDIS integration determined.
- Take a prospective, opportunistic approach to assessing new EDI resources for the enterprise and unique LOBs. Evaluate ROI for new EDI projects in collaboration with IS. Prioritize activities based on ROI.
- Develops and implements data-driven solutions to meet business requirements by producing analytics, reports, and data sets.
- Ensures the maximum level of data accuracy, integrity, consistency, and completeness in various internal and external data sources used for end-user reporting purposes (e.g., Oracle data warehouses, various supplemental data sources).
- Identifies data-related issues, and conducts root cause analyses; facilitates resolution of known issues by working directly with end-users and IT staff.
- Establishes business rules for accurate use of reporting data fields.
- Identifies new and maintains existing sources of data to ensure the availability of information for reporting purposes. Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all LOBs. Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues, and facilitates resolution of such issues.
- Actively communicate with senior leadership across business functions and teams to ensure that all parties understand current activities, successes, and barriers requiring escalation.
- Assist business teams with coordination and planning of all data intake activity to ensure predictable outcomes and appropriate escalations
- Assist team in continual refinement of business processes to gain efficiencies and increase productivity.
- Work with database managers and IS to insure that data is ingested and curated in a manner that insures data provenance and referential integrity are maintained.
- Hires, participates in and/or recommends development measures and disciplinary actions up to and including termination, evaluates performance, and supervises the work of all direct and indirect reports following established organizational policies, procedures, and practices.
- Motivates and encourages staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
- Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contribution.
- Acts as a mentor to junior associates to assist with personal and professional growth.
- Supports the VP HEDIS Strategy & Analytics in defining and attaining strategic goals.
- Bachelor's Degree.
- Master's Degree preferred.
- Experience with process improvement and workflow design.
- Experience with Agile / LEAN methodologies.
- Clinical background preferred.
- Deep understanding of clinical ontologies and code sets: SNOMED, LOINC, ICD, etc.
- Background in use of statistical process control techniques
- Strong background in clinical quality management.
- Familiarity with HEDIS technical specifications.
- Background in database design.
- Strong skills in at least one database query language (SAS, SQL).
- Foundation in at least one programming language preferred (Python, Java, C++).
- 3 years healthcare data experience.
- Experience with provider relations.
- Working knowledge of National Interoperability and Clinical Data Exchange standards including HL7 standards and healthcare related EDI technologies.
- Familiarity with HEDIS technical specifications.
- Excellent verbal and written communication skills, including communication with executive leadership.
- Strong organizational, process development/documentation and knowledge sharing skills.
- Strong interpersonal skills including relationship building.
- Proven ability to lead matrixed teams in a fast-paced enterprise environment.
- Ability to work tactically while developing strategic solutions to business problems in parallel.
- Alignment with the AmeriHealth Caritas mission of helping people get care, stay well and build healthy communities with a special concern for those who are poor.
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