Manager, Medical Management Outcomes


Posted: 01/31/2020 Category: HASH(0x7f3acc1fe7b0) Job Number: 37062

Job Description

Healthcare Analytics Manager-Medical Management Outcomes

New York, NY


Job description

Evaluate, design, develop and implement medical management initiatives to support the business needs through various clinical analysis

  • Develop and analyze various clinical data and reports on medical management programs, including authorization, utilization and case/disease management
  • Develop databases, set benchmarks, identify root cause and recommend improvements
  • Develop, create and implement database or automation to support and eliminate manual updates to programs within medical management
  • Research, identify, and monitor provider utilization trends and monitor providers for adherence to contract provisions. Report trends and refer cases for further investigation
  • Conduct audits and ensuring consistency with all contractual requirements
  • Respond to all inquiries related to provider assignments
  • Establish criteria and strategy for pilot programs and advise on guidelines and system modifications that affect claims processing and payment decisions

  • Bachelor’ s degree in Healthcare, Business, Quantitative science or related field.
  • Advanced knowledge of SQL and at least proficient in SAS
  • 4+ years business or clinical data analysis.
  • Experience with medical coding practices, groupers and reimbursement practices.
  • Comprehensive knowledge of current medical practices covering a broad range of medical specialties especially neonates and newborns.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • Provider and claim systems (CCMS and Amisys) experience preferred.
  • Knowledge of ICD-9, DRG’ s and CPT codes preferred.
  • Database management, SQL, Crystal Reports and/or COGNOS experience preferred.


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