AVP, Healthcare Economics

EmblemHealth Job Opportunity

Build new healthcare data analytic capabilities; implement healthcare economics programs in collaboration with enterprise business and functional units; set priorities and drive value creation that enhances our healthcare clinical value proposition; drive efficient, affordable, and accessible care management and delivery, and facilitate our business growth and expansion.

Define and implement Emblem's healthcare economics strategy to support the enterprise vision and mission.

Oversee the development of predictive analytics modeling to assist the company in effectively understanding future cost of care trend drivers and their financial and pricing impacts.

Direct and manage the Medical Economics staff to facilitate standard reporting and ad hoc analysis.

Perform / lead root cause analysis exercises to identify potential recovery / avoidance opportunities from problems due to undiscovered system or other issues.

Lead projects focused on care management, disease management and quality management optimization, working with stakeholders to identify and execute opportunities for improvement.

Analyze issues using enrollment, utilization, clinical, medical management, financial and other corporate data, and information from both modeled internal data as well as disparate internal and external sources.

Identify necessary data, data sources and methodologies.

Responsible for the development of models that identify the causes for variation in medical costs, and the development of reports that summarize this information effectively so that appropriate actions can be taken.

Develop and maintain project work plans, including critical tasks, milestones, timelines, interdependencies and contingencies. Adhere to corporate standards for performance metrics, data collection, data integrity, query design, and reporting format to ensure high quality, meaningful analytic output.

Work closely with IT on the ongoing improvement, driven by strategic and business needs, and designed to ensure data and reporting consistency throughout the organization.

Work collaboratively with stakeholders from across the organization to provide information, insights and business intelligence solutions that contribute to sound strategic planning, decision-making, goal setting, and effective performance measurement.

Identify and understand data from internal and external sources for competitive, scenario and performance analyses, and financial modeling to gain member / provider insight into new and existing processes and business opportunities.

Delegate or providing direction and feedback to staff when appropriate.

Assist and teach others within the organization how to define meaningful process and performance measures, develop data queries, and generate and management reports effectively.

Share development and process knowledge with analysts to assure consistency and continuously build a core of analytical strength within the organization.

Bachelor's degree in Mathematics, Statistics or related degree required, Master's preferred

10 12+ years of relevant, professional experience, including 3+ years of leadership experience at a director, manager or equivalent level, leading a medical economics, actuarial informatics, or analytics team required

7+ years of medical economics, actuarial informatics, analytics or highly impactful reporting development experience for a health provider, plan or managed care organization required

Working knowledge of health care EMR / claims systems (Epic / Clarity, eCW, Facets, QNXT, Amisys, etc.) required

Knowledge of New York State Medicaid and CMS Medicare regulations and related reporting requirements such as STARS, QARR, MMCOR, MEDS, RAPS, EDGE and HEDIS required

Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required

Strong analytical skills and ability to perform complex analysis and make recommendations based on statistical inferences required

Strong working knowledge of Business Intelligence products such as Tableau, Information Builders, Dimensional Insights, SAP / Business Objects, SAS, MicroStrategy, etc. preferred

Strong working knowledge of scripting or data mining tools (SQL, R, Python, SAS, Java / MapReduce, Aster, etc.). required

Demonstrated ability to exercise critical thinking and logical reasoning and understand the conceptual framework and database relationships underlying health care data required

Excellent communication skills (verbal, written, presentation, interpersonal) with all types / levels of audiences required

Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, SharePoint, etc.) required