Manager, Medical Management Outcomes

NY

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

Qualifications:
  • 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.

 

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.