Job Information
WellSense Medical Management Program Analyst in United States
Medical Management Program Analyst
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294317)
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
Reporting to the Director of Operations, Utilization Management, the Medical Management Program Analyst (MMPA) plays a key role in the implementation of new medical management systems, the evaluation of medical management activities and business processes and the development of a best in class utilization management (UM) program. The MMPA coordinates data management activities and ensures data integrity and quality in the business systems as well as various reporting databases within the Office of Clinical Affairs (OCA).
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
Key Functions/Responsibilities:
Consult with subject matter experts to identify information needs and outline optimal reporting formats to achieve business objectives.
Formulate and implement validation strategies and methods to ensure accurate and reliable data.Identify training needs in conjunction with UM Clinical Trainer.Act as SME for manual reports validation.
Create and maintain documentation, such as identified issues, summary of data, analysis, written interpretation of results, and related recommendations.
Identify key milestones and delivery dates, gather stakeholders and work groups, and coordinate submissions of internal customers to support timely, successful program reporting and data analysis.
Assist with integration of Medical Policy, UM, Pharmacy, and Care Management programs.
Design and build cost, utilization and business process reporting that captures key performance indicators and areas of strategic enhancement. Identifies trends and opportunities for improvement.
Identify opportunities for improvement in the UM/medical management program and manage complex processes from end to end to establish feasibility, ROI, project timelines interdisciplinary support, and testing.
Coordinate major work deemed of critical importance (e.g. ad hoc requests, cost savings initiatives) utilizing project management principles and documentation.
Facilitate intra-departmental, cross-departmental and cross-organizational project teams.
Manage high visibility, complex projects.
Participate in regulatory and compliance audits as needed to provide UM data analytic support
Develop technical logic for analyses to evaluate the effectiveness of medical management activities and programs to include tying results to specific financial or other targets. Has a keen understanding of clinical data.
Provides UM Department quality audits, productivity, operational and ad hoc reports.
Qualifications:
Education and Licensure:
- Bachelor degree in Health Care Management, Public Health, Nursing, Information Technology/Computer Science or other health care field required
Experience Required:
Minimum of 3 years of experience in a managed care environment required
4 years of progressively responsible experience in data modeling, informatics and analysis. Commensurate educational experience in related field will be considered.
Preferred:
2 or more years of experience in Medicaid Managed Care organization strongly preferred
Project management experience
Experience with system integration projects including conversion, transitioning and consolidating business to new application platforms
3 or more years of experience as a data programmer in a relational database environment including MS Access
Certification/Conditions of Employment:
- Pre-employment background check
Competencies, Skills, and Attributes:
Advanced Microsoft Access and SQL programming skills
Strong analytical and problem-solving skills including but not limited to interpreting alpha-numeric data and identifying outliers and trends
Proficiency preparing spreadsheets, graphs and other presentation materials
Knowledge of health care data sets including ICD-10, CPTs, DRGs
Ability to plan, organize, and manage projects in order to meet established deadlines
Understands testing methodologies for functional, systems, integration, performance and UAT
Proficient in compiling information from multiple sources
Attention to detail with excellent proof reading and editing skills
Ability to meet deadlines, multi-task, and problem solve in a fast-paced environment with changing priorities
Effective communication skills (verbal and written)
Ability to manage relationships with internal and external contacts
Ability to work effectively both independently and within a collaborative team
Proven ability to maintain confidentiality
General knowledge of medical management systems and utilization management
Working Conditions and Physical Effort:
Work is normally performed in a typical interior/office work environment
No or very limited physical effort required. No or very limited exposure to physical risk
Rare travel may be required
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294317)
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