Data Manager, Health Plan Services

LOCATION / DEPARTMENT:

HEALTH PLAN SERVICES

9AM – 5PM

This position is exempt from Career Service under the CCH Personnel Rules.

The Data Manager, Health Plan Services supports the analytic needs of the department. Assists with complex data projects and reports for performance improvement initiatives, department reports, provider and provider group report cards and required reports needed for National Committee for Quality Assurance (NCQA) accreditation and Federal and State requirements.

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures, and provision of applicable collective bargaining agreements

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policy and procedure
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

• Utilizes a variety of data sources to obtain data for member eligibility and demographics, claims, utilization management, care management, pharmacy, provider and provider groups, surveys and Healthcare Effectiveness Data and Information Set (HEDIS).
• Produces data, reports and analysis for population assessments, Utilization, Care Management, Quality, Annual Report, Centers for Medicare and Medicaid Services’ (CMS) Part C and D data validation reports, performance measures, performance improvement projects, medical cost action plans, research of programs and special tasks and projects.
• Collaborates with teams including Utilization Management, Quality, Care Management, Long-term services and supports (LTSS) and Behavioral Health to identify needed data for reports.
• Produces reports to determine trends and opportunities for improvement.
• Participates in and contributes data as needed for performance improvement and health plan governance committees.
• Provides reports for performance improvement projects and initiatives.
• Creates workflows, data collection tools and data presentation formats to standardize procedures and optimize best practices for department and projects.
• Provides deliverables for reports in compliance with federal, state and NCQA technical specifications and requirements.
• Produces scorecards for providers and groups for quality, utilization, care management, clinical outcome data, HEDIS data STARS data.
• Assists in the development of presentations for key stakeholders.
• Prepares and tracks invoices and payments of vendors utilized by the Clinical team.
• Performs other duties as assigned.

• Bachelor's Degree from an accredited college or university in Finance, Economics, or related quantitative field with two (2) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)

Bachelor's Degree from an accredited college with four (4) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)

• Master’s degree in finance, Economics or related quantitative field from an accredited college or university is preferred
• Knowledge of Medicaid and Medicare reporting is preferred
• Knowledge of Healthcare Effectiveness Data Information Set (HEDIS) is preferred
• Knowledge of Medicare STARS is preferred

• Knowledge and proficiency with SQL
• Proficiency using Microsoft Office Suite including complex formulas in Microsoft Excel such as V-Lookups and Pivot Tables
• Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups

• Demonstrate attention to detail, accuracy, and precision
• Ability to analyze and reconcile large data sets
• Ability to quickly gain a thorough…