Lead Analytics Manager - Value Based Care

Overview:

The Lead Value-Based Care Analytics Manager supervises the development and presentation of advanced analyses on clinical, financial, and operational performance using various healthcare data sources such as claims, clinical records, and operational data. This role is crucial in evaluating and guiding strategic decision-making within the organization, with a specific focus on value-based care and risk-based programs. Expertise in healthcare claims analytics, clinical quality assessment, coding practices, care team management, and analytical tools is essential for this role. Additionally, the Lead Value-Based Care Analytics Manager supports the professional growth of team members, collaborates with key stakeholders across the enterprise, interacts with CMS and national and regional payors, and delivers analysis reports and recommendations to senior leadership on a regular basis. This role is a key member of the Value-Based Care Institute (VBCI) products and analytics team and operates with a high level of autonomy.

Responsibilities:

Data Analysis & Performance Monitoring

• Deliver oversight and professional perspective on the examination of claims, clinical, and operational data to gauge performance in value-based arrangements.
• Ensure effectiveness in the supervision and reporting of critical performance metrics (KPIs) such as total care expenditures, quality benchmarks, risk appraisals, utilization rates, and shared savings measurements.
• Provide direction and management for establishing, applying, and overseeing reports and dashboards to evaluate contract efficiency and uncover possibilities for enhancement.

Modeling & Financial Impact

• Assist in the process of financial forecasting and impact analysis for contracts based on value and risk, including programs from CMS and CMMI, Medicare Advantage, Medicaid, Commercial insurance, Direct to Employer setups, and bundle payment schemes like CMS TEAM.
• Support in budget strategizing, projecting performance trends, and calculating joint savings or deficits.
• Assess benchmark techniques, trend components, and attribution reasoning to back negotiations and strategic decisions.

Quality & Outcomes Analytics

• Evaluate and monitor quality performance through the lens of HEDIS, STAR ratings, CMS quality schemes, and individualized indicators.
• Coordinate with medical professionals to highlight gaps in patient treatment and locate areas where improvements can be made.

Contract & Program Support

• Assisting in the analysis to bolster the development, execution, and assessment of innovative value-focused arrangements.
• Analyze intricate payer contract conditions to create measurable analytic aims.

Cross-Functional Collaboration

• Interact with leaders at all levels across the enterprise and diverse healthcare settings to drive the analysis of value-based care outcomes and strategies for performance enhancement.
• Contribute to workstreams that span across systems and networks, offering perspectives on analytics and value-driven care
• Direct the preparation of presentations, executive summaries, and board-level updates related to value-based care contracts and initiatives.

Qualifications:

EDUCATION:

Formal training or work experience in data analytics, data analysis, or data science.

Minimum of 10 years of experience. A bachelor's degree is considered to meet 3 years of experience; a master?s degree is considered to meet an additional 1 year of experience, and a doctorate degree is considered to meet an additional 2 years of experience. Other relevant formal training in data analytics and/or healthcare analysis and operations may be considered on a case-by-case basis.

EXPERIENCE:

• Experience working and knowledge of a variety of healthcare data sources including claims data, payor revenue/premium data, payor supplemental data, clinical data including clinical quality metrics (HEDIS) and risk adjustment (HCCs), social determinants of health (SDOH), and operational data and KPIs.
• Ability to oversee data quality and data integrity and oversee related vendor work Expert-level experience using data and analytics tools. Deep experience using SQL and at least one analytics or visualization tool (PowerBI, Tableau, SigmaComputing, or other) and working in modern data infrastructure (Snowflake or Databricks).
• Experience providing analysis and analytics for value-based contracts including experience working closely with healthcare payors across all lines of business (Medicare, Medicare Advantage, Commercial, Medicaid, Direct to Employer)
• Knowledge of and experience with healthcare claims data and related claims analytics tools (such as Milliman?s MedInsight, MedeAnalytics, Tuva or claims analytics tools)
• Knowledge of and experience with electronic health records (EHRs, such as Epic, Cerner, eCW, Allscripts, Athena)
• Understanding of clinical workflows and clinical operations as they relate to value-based care and population health
• Ability to communicate complex analysis to non-technical leaders and decision-makers including verbally, in writing, and through effective visualizations.
• Ability to engage with data engineering and related technical teams to ensure data quality and data integrity.
• Genuine curiosity to dive deep into healthcare data and uncover insights and root causes.
• Deep commitment to continuous learning as part of a cross-functional team that includes clinical and non-clinical stakeholders.

Preferred Experience

• Experience working within an agile delivery environment (DevOps)
• Knowledge of and experience with population health management platforms (such as Epic's Value Based Care, Innovaccer, Arcadia, Lightbeam or other care management or population health platforms)

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