Senior Manager, Quality and Risk Analytics

Job Summary

 

This role will drive the execution of the analytics strategy and projects to deliver data-driven insights to achieve optimal patient care and outcomes by supporting AbsoluteCare’s clinical, financial, and operational goals. This role will lead the development of standard tools and innovative data solutions to inform strategic business decisions and ensure that our members receive the right care, at the right time, and at the right place.

 

This role involves leading a team and overseeing detailed business requirements, designing and developing reports, and conducting analyses using healthcare utilization, operational, clinical, and financial data from various healthcare information sources to predict, measure, and enhance member and care model outcomes.

 

This position will oversee analytical projects utilizing data from the Electronic Health Record (eClinicalWorks), pharmacy point-of-sale system, population health management systems, third party vendors, and health plan payer data. The aim is to deliver comprehensive solutions that address key business needs and align with enterprise strategy.

 

This role will specifically partner with clinical leadership to develop and deploy data and analytic solutions to align with the Quality and Risk Adjustment strategy and goals for the organization.

 

 

Duties and Responsibilities

 

• Lead the planning and execution of the design and recommendations of data strategy, data framework, analytical approaches and methodology supporting critical business needs across the organization, specifically supporting Quality/HEDIS analytics and Risk Adjustment/analytics.  
• Serve as a primary liaison with business teams, leadership, and technical partners to define, create, document, and implement ad-hoc reports/analytics that support the AbsoluteCare clinical care model and strategy.

 

• Build and implement data driven standard solutions to support AbsoluteCare’s Quality program based on NCQA, HEDIS, and CMS Stars to measure and improve healthcare outcomes.
• Build and implement data driven standard solutions to support AbsoluteCare’s Risk Adjustment Payment System program based on CMS-HCC model, CDPS + RX, and other best in class strategies
• Ensure data models are standardized across multiple data sources, including health plan claims, EHR, care management systems, and other outside vendors
• Develops and provides oversight of data-driven KPI’s that identify issues, mitigate risks and provide actionable insights for leadership in setting strategic direction(s).
• Supports leadership in an analytical role in building, maintaining, and improving the existing capabilities, business intelligence, and analytics tools across AbsoluteCare.
• Leads the development of analytical models and defines the business KPIs alongside senior leadership
• Collaborate with clinical, financial, operational leadership to ensure strong partnerships, align all business needs, leverage cross-functional skills, to define opportunities and areas to focus on to optimize the delivery of AbsoluteCare model of care and co-develop valuable analytic solutions
• Mentor, manage, and ensure the continuous development of a team of leaders and analysts

• Maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company’s patients, employees, and business partners.

• Implement data governance practices to maintain data integrity

• This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned.

 

Minimum Qualifications

 

• Bachelor's degree in economics, information technology, statistics, mathematics, actuarial science, health sciences or related field required; Advanced degree preferred.
• Required 7+ years of experience in a similar position in a health plan or health care organization. Health plan or value-based provider experience preferred.
• Experience with value based alternative payment models with downside risk sharing between providers and health plans strongly preferred.
• Strong background and deep understanding of health care data, business concepts, and managed care within the go