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Network Contracting East/VT, Sr. Leader, Network Analytics_B

625 State St, Schenectady, NY 12305, USA Req #314
Wednesday, October 2, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

This role will help advance Network Performance for MVP Health Care.

The individual will be the lead data strategist responsible for evaluating Network Programs, including VBP and APM arrangements, and the overall performance of MVP Network Provider Partners. This individual will support the identification and selection of relevant clinical, financial and administrative information to share with and acquire from provider partners in value-based agreements. Along with his/her team, this individual will provide analytic support for all aspects of Strategic Network Program Management including financial, quality improvement measurement, care management/case management, social determinants of health and ad hoc analyses to assist in program activities.

The role will develop reporting mechanisms that aim to ensure timely delivery of accurate information to internal and external audiences. Support data modeling, including analyzing large data sets to derive actionable insights from data gathered across multiple healthcare platforms i.e. CM/UM/DM, claims adjudication systems, quality, external sources etc. Pioneers and develops data visualizations solutions that integrate data sources to create insightful and actionable information.

The Senior Leader will represent Network on committees and task forces related to strategic MVP initiatives, such as: data sharing and acquisition, data governance and reporting consistency for both internal and external consumers. This individual will coordinate business process improvement and automation initiatives with IT, Informatics and/or Actuarial teams and the appropriate business process owners.

POSITION QUALIFICATIONS

Minimum Education Bachelor’s degree required. Master’s degree preferred in one of the following areas: healthcare (e.g. health administration, public health) or information systems (management information systems, analytics, engineering) or related field. Minimum Experience Seven years or more experience managing analytics using clinical data (electronic health records), healthcare claims, or provider quality measures, preferably for a health plan, consulting firm, provider group, health system or a software vendor that offers data solutions to health systems or providers. Five or more years of management experience.  


Required Skills
 
• Ability to convert business strategies into measurable results.
• Ability to develop, maintain and manage a budget.
• Ability to translate complex data and models to senior management, business unit leaders and external stakeholders.
• Innovative, strategic thinking to solve both today’s and tomorrow’s analytic problems.
• Knowledge of alternative payment and financial models.
• Demonstrated leadership experience in a fast paced, high volume, highly available with the ability to lead change through people, process and technology.
• Knowledge of administrative datasets (i.e. claims, eligibility, etc.) reporting /analytic uses (e.g. cost and utilization reporting, disease management, etc.) and terminology (e.g. PMPM, and per 1000 measures, diagnosis/procedure codes, episode groupers, risk adjustment, etc.).
• Understanding and experience with the Healthcare Effectiveness Data and Information Set (HEDIS) and New York State’s Quality Assurance Reporting Requirements (QARR).
• Knowledge of VBP and APM programs; specific knowledge of NY, VT and CMS programs is a plus.
• Knowledge of clinical care processes and related data elements (e.g. ADT, laboratory, imaging, pharmacy, etc.) across care settings (acute care, primary care, rehabilitation, long term care, home care, etc.).
• Knowledge of PowerBI and TriZetto’s Facets applications a plus.
• Knowledge of electronic medical record (EHR) technology as well as Health Information Exchange (HIE) as it relates to health plan operations and monitoring is a plus.
• Must be self-motivated, proactive and able to work well under pressure.
• Proven ability to build relationships with business and technical partners to improve customer service and continuously improve project delivery.
• Regularly communicate the status of initiatives to Network leadership and business partners.
• Support continuous process improvement and innovation.
• Maintain confidentiality and adherence to regulatory compliance issues.
• Proficient in personal presentation, verbal, and written communication.
• Occasional travel, including overnight travel. • Performs other related duties as assigned.

MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

Other details

  • Job Family Network Management & Development
  • Pay Type Salary
  • Travel Required Yes
  • Required Education Bachelor’s Degree
  • Job Start Date Wednesday, October 2, 2019
  • 625 State St, Schenectady, NY 12305, USA