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Sr. Medical Management Operations Data Analyst

ConnectiCare – Farmington, CT

ConnectiCare is a leading health plan in the state of Connecticut. A local company for more than 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. By striving to make it easy for members to get the care they need, ConnectiCare leads the individual market in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance. ConnectiCare is a subsidiary of EmblemHealth.

Were looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.


Summary of Job: Responsible for development of reporting and analytics to drive change and measure health care value. This individual will be responsible for creating the information that will empower internal associates to identify areas of opportunity to make meaningful changes to the cost and quality of health care being delivered to Plan members.


Responsibilities:

  • Develop operational reports that allow management to effectively manage the business.
  • Develop, implement, and maintain leading-edge analytic systems, taking complicated problems and building simple frameworks.
  • Be responsible for evaluation of current systems against new business needs. Gather and document business requirements, ensure innovative, efficient solutions delivered are designed to meet business needs.
  • Act as the liaison between Medical Management Operations and Technology to drive closure to production issues.
  • Identifies areas for data quality improvements and helps to resolve data quality problems through the appropriate choice of error detection and correction, process control and improvement, or process design strategies.
  • Create and maintain rich interactive visualizations through data interpretation and analysis integrating various reporting components from multiple data sources
  • Conducts and coordinates cross-functional analysis of health care data to identify trends, explain results, and discover opportunities for improvement. Communicates findings to clinical operations management and appropriate stake-holders.
  • Design, develop, and implement ongoing data validation processes.
  • Derive and validate universes required for quality monitoring and auditing, state, federal and accreditation audits.
  • Develop standard and adhoc reporting and analysis as required
  • Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations.
  • Works with internal stakeholders to determine appropriate information for corrective action management reports.
  • Performs other related projects and duties as assigned.


Required Skills

Qualifications:

  • Requires Bachelors Degree in Actuarial Sciences, Decision & Information Sciences, Medical Informatics, Finance or related quantitative field and 5-7 years of experience in the design, development, and management of informational analysis tools. In lieu of a Bachelors degree and 5 years of experience as stated, we will accept a Masters degree in one of the stated fields and 3 years of work experience, and will view one year of Ph.D. studies as equivalent to each year of required work experience as stated on a one to one basis
  • Previous work experience in utilization management and trend analysis required preferably within a managed care environment
  • Must have previous work experience in interpreting financial results and explaining variances
  • Ability to use raw data to create meaningful reports through working knowledge of relational database principles including SQL and MS-Office products (particularly MS-Access)
  • Experience with Tableau is a plus
  • Excellent quantitative and analytical skills
  • Knowledge of medical terminology and coding methodologies required. HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG s required
  • Good oral and written communication skills with work experience in presenting analysis to key stakeholders to support strategic business decisions
  • Good project management skills

Essential Job Requirements:

  • Primarily sedentary
  • Must be able to use standard office equipment

ConnectiCare is an equal opportunity employer. M/F/D/V ConnectiCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Required Experience

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