Clinical Analytics Analyst IV

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary :

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi-disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to providers and health care value to members and employer customers.

As a subject matter expert, the role collects business requirements, translates business requirements into analytics design, define data & analytics specifications, manipulates and analyze large healthcare data from various data sources, and interpret the findings to inform opportunities and solutions that improve clinical quality and increase cost efficiency and health care affordability. This position requires sound data analytic programming skills with robust knowledge and understanding of the healthcare business and data.

Responsibilities :

Acts as the analytic lead for complex clinical analytics projects involving multiple data resources and teams to inform business decisions in clinical, network, value-based payment models, and employer engagement.

Understands the strategic direction of the organization and the analytic and reporting requirements to meet departmental needs. Translates business questions and needs into analytics technical requirements including data analytics design, clinical and data specifications, and reporting format.

Leads the design and extraction of data from multiple sources. Creates integrated analytic datasets. Performs analytics and summarizes findings to inform business opportunities and address business questions.

Provides insight and guidance into analytic findings (including root causes and contributing factors – both actionable and not) through clear, professional, succinct written and oral summaries, tables, charts, reports, or presentations.

Navigates across multiple analytical and business units to socialize and gain buy-in for analytics design, results and interpretation, including making recommendations on how to use the results to inform business decisions.

Ensures appropriate use of analytic tools and programming techniques for analytics efficiency.

Builds quality assurance criteria and processes to ensure data and analytics results accuracy and consistency.

Documents methods, specifications and findings clearly. Collaborate with team members to document work appropriately, including SAS coding comments and use of analytic plan / timeline where needed for analytic projects.

Present analytics findings to internal leadership teams and external provider partners to inform actionable opportunities and solutions.

Provide technical trainings (analytics design, data, programming, QA, statistics, documentation, etc.) to junior analysts.

Disclaimer :

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education / Experience :

High School Diploma / GED required.

Bachelor degree in Math, Statistics, Data Science, Economics, Epidemiology, Public Health, or related field preferred or relevant experience in lieu of degree.

Prefers a Master degree in Math, Statistics, Data Science, Economics, Epidemiology, Public Health, or related field.

Requires a minimum of 10 years of experience in Data Analytics, Informatics, Medical Economics or other relevant work experience.

Requires a minimum of 10 years of experience performing analysis on large healthcare administrative claims data, EHR / EMR data, or complex relational health care databases with significant experience analyzing medical, pharmacy, and behavioral health claims data.

Requires a minimum of combined 10 years hands on programming experience using SAS or SQL.

Knowledge :

Requires extensive knowledge of US healthcare industry, health plan business, claims data, clinical data, and coding practices.

Requires proficiency with MS Excel for data analysis and reporting.

Requires solid organizational skills and attention to details.

Requires strong ability to work in a fast-paced team-oriented environment and strong ability to manage competing priorities. Must be highly motivated and able to work independently.

Prefers knowledge and working experience of visualization and BI tools (e.g., Tableau, Power BI.) with preference given to Tableau experience.

Prefers hands-on experience of clinical episode groupers and analytics, preferably with Optum’s Symmetry Suite of Services (Impact Intelligence, ImpactPro, ETG, ERG, PEG, EBM, PRG, etc.) or PROMETHEUS.

Prefers knowledge and direct experience of Milliman’s analytics tools such as MedInsight Health Cost Guidelines (HCG) Grouper, Milliman Advanced Risk Adjusters (MARA), MedInsight Benchmarks.

Prefers knowledge and experience of statistical tests and predictive modeling.

Salary Range : 121,200 - $165,375

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes :

Comprehensive health benefits (Medical / Dental / Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Salary : $121,200 - $165,375