Director, Clinical Analytics

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary :

Lead clinical analytic delivery by aligning strategic objectives with the development of analytics priorities, capabilities and reporting tools.

This position is a key team leader collaborating in a multi-disciplinary business environment with colleagues across the enterprise to drive health care value improve clinical care quality and reduce total cost of care.

Responsible for directing clinical analytics activities in the areas of alternative payment models which include primary care value-based payment models, Specialty Care / Episode of Care / Bundled payment models, and capitation, clinical performance measurement, clinical insights development and reporting to provider and employers, and home-based care strategy.

Operations and management of the Nuna / replacement including : accountable for replacement development, testing, QA, validation, and implementation for value based programs for all LOBs, EOC / Specialty Care, new vendor implementation for Specialty Care / Episode of Care.

Work with functional leaders to understand business needs and gather requirements; design analytics method and plan; direct analysts to conduct complex clinical data analytics, develop innovative alternative payment models, and set financial targets, provide financial reporting;

draw key business insights and present the findings with recommendations to functional leadership for business decisions.

Responsibilities :

Prioritize and direct the planning and execution of clinical analytics strategic initiatives and projects, supporting the translation of health care value goals into actionable solutions.

Acts as the analytic team lead for complex clinical analytics projects involving multiple data resources and cross-functional teams to inform business decisions in clinical, network, product, alternative payment models, and employer engagement.

Prioritize team work and manage executive customer expectations, deliverables, and relationships.

Responsible for SHBP Clinical Performance Guarantee monthly reporting to monitor performance compared to targets and provide actionable information on patients with care gaps.

Responsible for SHBP value-based program monthly reporting and audit, which include attributed members by value-based providers, quality and cost performance, APP payment, and shared savings payment forecasting and reconciliation.

Lead value-based program quality analytics and provider reporting, provider scorecard and Braven value-based program scorecard.

Responsible for provider Clinical Insights Development and Reporting for VBP, Specialty Practices, and Facility to drive clinical improvement in quality and affordability.

Accountable for NUNA replacement development, testing and implementation for VBP all LOBs and EOC / Specialty Care.

Maintain alignment of team goals and resource deployment with strategic objectives and the business needs of multiple health plans and corporate stakeholders.

Define, design, prioritize and delegate analytics tasks and responsibilities to data analytics team members

Serve as a primary domain contact as well as key point of escalation and accountability to ensure customer partnership and satisfaction.

Lead the realization of analytics strategy as set by executive governance and internal leadership teams

Guide and partner with leaders across analytic domains to ensure strong partnerships, align all business needs and analytics processes, leverage cross-functional skills, and co-develop valuable analytic solutions

Manage, develop and train 16-19 staff members of five teams. Develops and monitors goals, and conduct annual performance reviews.

Ability to manage a growing team and drive a culture that supports our mission, vision, and strategy.

Mentor and provide cross-functional training to ensure the continuous development of a team of leaders and analysts in Clinical Performance Measurement and Predictive Analytics department.

Understands the strategic direction of the organization and clinical analytic and reporting requirements to meet departmental needs.

Translates business questions and needs into analytics technical requirements including data analytics design, clinical and data specifications, and reporting format.

Leads the design and extraction of data from multiple sources. Creates integrated analytic datasets. Performs analytics and summarizes findings to inform business opportunities and address business questions.

Provides insight and guidance into analytic findings (including root causes and contributing factors both actionable and not) through clear, professional, succinct written and oral summaries, tables, charts, reports, or presentations.

Navigates across multiple analytical and business units to socialize and gain buy-in for analysis design, results and interpretation, including making recommendations on how to use the results to inform business decisions.

Ensures appropriate use of analytic tools and programming techniques for analytics efficiency.

Builds quality assurance criteria to ensure data and analytics results accuracy and consistency.

Documents methods, specifications and findings clearly. Contributes to writing and presentation of results, findings and conclusions to management and leadership.

Ensures analysts document work appropriately, including SAS coding comments and use of analytic plan / timeline where needed for analytic projects.

Effective communication of business insights and project goals.

Must have Clinical Data Analytics expertise and leadership experience.

Disclaimer :

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification.

It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education / Experience :

High School Diploma / GED required.

Bachelor degree in Math, Statistics, Data Science, Economics, Epidemiology, Public Health, or related field preferred or relevant experience in lieu of degree.

Requires a minimum of 10 years of experience in Data Analytics, Informatics, Medical Economics or other relevant work experience.

Requires a minimum of 10 years of experience performing analysis on large healthcare administrative claims data, EHR / EMR data, or complex relational health care databases with significant experience analyzing medical, pharmacy, and behavioral health claims data.

Requires a minimum of 10 years of experience programming in SAS.

Knowledge and working experience of visualization and BI tools (e.g., Tableau, Power BI.) with preference given to Tableau experience.

Knowledge and experience of statistical tests and modeling.

Proficiency with MS Excel for data analysis and reporting.

Requires a minimum of 7 years team management experience.

Extensive knowledge of US healthcare industry, claims data, clinical data, coding practices.

Solid organizational skills and attention to details.

Strong ability to work in a fast-paced team-oriented environment.

Strong ability to manage competing priorities.

Highly motivated and able to work independently.

Prefers hands-on experience of clinical episode groupers and analytics, preferably with Optum’s Symmetry Suite of Services (Impact Intelligence, ImpactPro, ETG, ERG, PEG, EBM, PRG, etc.

and Prometheus Episode Grouper

Salary Range : $150,300 - $205,065

$150,300 - $205,065

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity.

This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.

Horizon also provides a comprehensive compensation and benefits package which includes :

Comprehensive health benefits (Medical / Dental / Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.

Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.