The Medicare Analytics Consultant will lead the healthcare economics and analytics unit of the Delivery Network consisting of 22 Care Delivery Network (DN) medical center locations under the Pasteur and Wellmax brands. The centers provide primary care and other medical services to CMS Medicare Advantage patients who are all members of HealthSun Plans (HS) in Miami-Dade, West Palm Beach and Broward counties. Responsible for identifying and delivering data-driven insights and analytical support to the DN. Employs advanced analytics to gain critical insights into medical costs drivers, reimbursement and clinic performance, member behavior drivers and preferences, product/program concepts and value propositions, operational effectiveness and efficiencies.
Primary duties may include, but are not limited to:
- Utilize data analysis/financial modeling techniques to measure the potential financial opportunities/impacts of medical margin action plans
- Analyzes medical cost trends, uncover outliers and opportunities and identify potential cost savings to support managerial decision-making process.
- Enhances existing reporting capabilities, such as creating benchmarks, flash reports and other user requests.
- Leverages data analytics and medical modeling to provide insight into new and existing processes and business opportunities.
- Partners with Clinical, Network and Operational stakeholders to proactively measure and improve quality, patient outcomes and total cost of care performance.
- Measure and report the financial impacts realized as a result of the implementation of medical margin action plans.
- Provides analytical insights to support business solution development based on quality, use, cost and other key drivers.
- Develops and refines analysis templates for problem diagnosis and opportunities assessment.
- Consults on all considerations related to designing and executing tests or pilot programs.
- Contributes to the design of new program/initiative based on test/pilot outcomes.
- Develops targeting criteria or customer segmentation based on analytical insights, clinical inputs, product design and operations considerations.
- Develops predictive models and other tools that help target the right members.
- Develops methodology to measure clinical, utilization and financial outcomes of a program/initiative; conducts in-depth research to address challenging issues in measuring outcomes.
- Leads applied research projects.
- Authors white papers, presents at industry conferences and submits journal publications.
- Addresses limitation of certain data sources and evaluates incremental value of new data sources.
Minimum Requirements : Requires MS, MA, or PhD with concentration in a quantitative discipline such as Mathematics, Statistics, Economics, Epidemiology, Engineering, Computer Science or Operations Research and a minimum of 5 years experience in related health care analytics; or any combination of education and experience which would provide an equivalent background.
Preferred skills, qualifications and experiences : PhD preferred. Experience with developing expert modeling system for segmentation/stratification that supports customized strategies for different customer segments in a major industry highly desirable - healthcare, financial, database/direct marketing, online retails, consulting, etc. Substantial analytical experience in healthcare industry preferred. Advanced expertise with SAS or equivalent analytical tools and comprehensive experience with Teradata, SQL, or equivalent data base tools strongly preferred. Extensive knowledge of healthcare/medical economics data such as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs, risk adjustment, predictive modeling, and APCs. Ability to model financial concepts of ROI, IRR, etc.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.