Job Summary:
The Healthcare Analyst II is responsible for analyzing healthcare utilization to identify patterns, variation, and outliers as well as identify and quantify opportunities to reduce medical costs.
Essential Functions:
- Analyze healthcare utilization to identify patterns, variation, and outliers.
- Identify and quantify opportunities to reduce medical costs within the markets
- Evaluate the effectiveness of medical cost reduction initiatives.
- Support tracking and reporting of medical cost reduction initiatives.
- Work with Actuarial and Market Finance teams to accurately accrue and forecast the savings impacts of medical cost reduction initiatives.
- Develop tools to efficiently compare market performance across and within products.
- Provide analysis and recommendations to inform network provider performance improvement
- Monitor the efficiency and efficacy of clinical programs, interventions and processes
- Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
- Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s Degree or equivalent years of relevant work experience is required
- Minimum of two (2) years of experience in healthcare analytics is required
- Managed care experience is strongly preferred.
- Experience with healthcare analytics and financial analysis required, health plan preferred.
Competencies, Knowledge and Skills:
- Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
- Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is preferred
- Proficient in with Excel, Word and PowerPoint
- Proficient with Transact-SQL or SAS or Microsoft Power BI or Tableau
- Ability to organize data in a way that facilitates inferences, conclusions and decisions
- Demonstrated written and verbal communication skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$69,400.00 - $111,000.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
