Manager Healthcare Analytics - Medical Policy

Highmark Inc.

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.

• 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). Will 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.

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

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

Required

• None

Preferred

• Medical Coding

• 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%

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…