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Director, SHS Clinical Informatics & Analytics in Southfield, MI at AF Group

Date Posted: 10/17/2018

Job Snapshot

Job Description



SUMMARY:

This position is responsible for directing and leading Senior Health Services clinical informatics and analytic team that supports segment performance through clinical, cost and trend management. Informatics and analytics includes implementation of work products that identify claims trends and identify opportunities to reduce claim expense. The informatics and analytics team will also understand and support as necessary the accurate documentation of the burden of illness of the segment, Medicare Star measures and business unit performance.

The individual must be interactive with all levels of the company and operating unit management, insightful, and able to see above the details to the big picture. This position must be able to work on many tasks concurrently and use time management skills effectively to meet hard deadlines, along with prioritizing tasks with similar expectations. The ideal candidate will have a broad understanding of current analytic tools, analytic models, predictive analytics, and related applications, as well as having excellent written and verbal communication skills.



RESPONSIBILITIES/TASKS:

  • Develop SHS analytics that manage cost and trend
    • Working with other analytic teams across the Enterprise, perform research and analysis into claims costs and drivers, identify areas for improvements and savings
    • Collaborate with SHS leadership on product performance and profitability
    • Collaborate with enterprise finance, actuary and analytic teams on segment financial performance
    • Create cost and trend reports with drilldown views to support cost management initiatives
    • Support segment or enterprise strategic initiatives that reduce medical cost such as but not limited to utilization management, care management, provider value-based contracts
    • Collaborate with enterprise analytic resources to support predictive models that support cost management initiatives
    • Create and collaborate with enterprise governance efforts on data warehousing, analytic tools, data visualization, data security
  • Collaborate with analytic vendor(s) serving SHS to document of the burden of illness of the Medicare Advantage membership
  • Collaborate with analytic vendor(s) serving SHS to deliver initiatives that drive improvements to Medicare Star measures
  • Support SHS business unit, EM and BCBSM analytic teams as necessary
  • Supports with business unit, division and enterprise analytic strategy
  • Works within enterprise analytic operating model, governance and architecture
  • Prepares and presents, as necessary, analytic findings in oral and written formats for internal stakeholders and external customers
  • Stays current with industry trends and leads development of key data/analytics innovation platforms
  • Stay current on CMS rules and regulations that impact cost of care including but not limited to changes to payment models, payment rules, and payment innovation

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.