[Remote] Manager, Clinical & Business Insight

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

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