The Manager of Health Care Analysis plans and organizes activities required to collect, analyze, and present health care cost, utilization, quality, and clinical outcomes data. This position is also responsible for policy and procedure development to improve efficiency and ensure a focus on outcomes.
Essential Duties & Responsibilities
Responds to health care cost, utilization, quality, and other informational needs to comply with reporting standards such as NCQA, DOC, and HEDIS. Develops, validates and maintains methods, processes, algorithms and program coding for population identification, stratification and reporting based on defined standards. Supports standardized and ad hoc reporting for a variety of health care measures such as utilization and quality of care measures using claims and encounter data.Ensures quality and data integrity and creates validation and control criteria standards. Validates and verifies accuracy of reports and other outputs. Oversees study designs, analysis strategy and written reports for initiatives and studies.Completes ad hoc projects and represents health services on project teams as required. Uses research sources to extract, organize, summarize and analyze data, such as quality and outcomes. Prepares conclusions and forecasts based on data summaries and develops recommendations and alternatives for management review and presentation.Completes health care studies in response to issues that would affect health care delivery. Prepares and presents reports for management review that include conclusions, recommendations, and alternatives based on data summaries. Researches and recommends improved data reporting formats. Identifies and develops enhanced research sources and databases.Participates in collaborative initiatives and evaluates data collected to initiate improvement activities.Oversees and analyzes programs, initiatives and interventions and makes recommendations to improve established performance measures and coordination of care.May oversee the development and implementation of data systems programming required to extract any requested data.Coordinates staffing resources and activities and develops department budget.Performs management duties including, but not limited to, budgeting, supervising staff, staff development, performance management, staffing, coaching, corrective action, training, and ensuring performance standards and operating goals are achieved.Performs other duties, projects and special assignments as assigned.
- Bachelor's degree in Biostatistics, Statistics, Health Care Administration, a related field or a combination of education and work experience providing equivalent background; Masters degree strongly preferred
Government Clearance & US Citizenship Requirement
Five years database management systems (SQL, SAS, Focus, Access, etc.) experience in a health care/managed care setting or related clinical /research environmentFive years experience in research or project managementThree years supervisory/management experience.Experience processing and analyzing large databases, preferably in a VAX (or comparable) computing environmentORAny combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Knowledge, Skills & Abilities
Working knowledge of PC-based software programs (Business Objects, Word, Excel, etc.) and automated database management systems (SQL, SAS, Focus, Access, etc.) and spreadsheetsVerbal and written communication skillsPresentation skillsAnalytical and problem solving skillsAbility to analyze, apply, interpret, and communicate policies, procedures and regulationsWorking knowledge of health care data such as claims, pharmacy, authorizations, membership, etc., and medical terminologyKnowledge of guidelines such as NCQA and HEDIS and regulations such as DHS, DMHC and CMS
- The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication.
- Required to have speaking ability to express or exchange ideas.
- Constant computer usage including constant typing and/or eye strain.
- Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Significant phone usage; headsets may be required.
- Moderate travel may be required between work sites and/or out of area.
- Significant work in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Constant interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Constant thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one or several things to the next.
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability
About Health Net, Inc.
Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts.