Manager Healthcare Analytics - Medical Policy

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for the oversight and operations of the healthcare management analytics function with the Medical Policy department. The incumbent retains responsibility for development, implementation and management of complex analytical, research, and decision support activities which includes complex analysis, including statistical analysis, quantitative analysis, predictive modeling, data mining, segmentation modeling, campaign evaluation, simulation model implementation and testing, and content knowledge. Provides consultation and analytical expertise in the development and support of various projects and data analysis related to Medical Policy and Utilization Management.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Assure that all projects or initiatives are delivered on time and in accordance with the agreed upon scope. This includes both internally driven work as well as all work in support of strategic and tactical initiatives, corporate releases, or business as usual maintenance.
• Establish the vision and strategy for the function and determines how this function can best support the overall organizational strategic initiatives. Develop the scope, planning, execution and delivery of all functional related efforts, whether strategic phases or routine periodic work.
• Serve as the primary leadership contact within the department for healthcare management analytic capabilities with both internal (within the Organization enterprise) and external constituents (including consulting firms, facilities or providers). W ill be a focal point for the public face for the department’s participation in a variety of high-level healthcare management analytics efforts.
• Ensure that the company remains current with emerging industry best practices and techniques with respect to healthcare management analytical capabilities, which may include statistical modeling, predictive modeling, chart comparisons, matching strategies, and data visualizations using business intelligence tools.
• Other duties as assigned or requested.

EDUCATION

Required

Bachelor's Degree in MIS, Business, IT, or a related area, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• Master's Degree in Business Administration (MBA), IT or other related area

EXPERIENCE

Required

• 5-7 years of lead role experience in healthcare informatics, analytics, business intelligence or statistics with responsibility for: a) application of analytic capabilities in the solution of business problems OR b) consulting arrangements and/or management OR c) program and project management OR d) management of professional analytic staff in a business, clinical or technology function
• 5-7 years of experience solving business, financial and/or clinical problems. This includes using technologies and analytical methodologies, preparation of related recommendations and presentations of findings to various levels of management and external parties
• 3-5 years of management experience or similar experience in a supervisory capacity or role

Preferred

• Experience in Utilization Management and/or Medical Policy

  Experience working with claims data

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• Medical Coding

SKILLS

• Agile Application Development
• Business Intelligence Tools (Cognos, Tableau, Business Objects)
• Analytical Skills
• Data Analysis
• Excellent Multi-Tasker
• Microsoft Office
• SAS, SQL
• Critical Thinking, Creative Problem Solving

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$92,300.00

Pay Range Maximum:

$172,500.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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