Manager of Healthcare Data Analytics - Manning - Administration

The primary goal of the El Rio Health

Manager of Healthcare Data Analytics is to support El Rio’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.\nEssential Job Functions : \nFinancial Measurements : \n\nUnderstands El Rio Health current contracts - potential earning from each based-on Quality / Shared Savings / PAF forms and dollar based on panel size.\nCollects and analyzes financial and clinical data to evaluate the effectiveness of value-based care programs. \nTracks key performance indicators (KPIs) related to quality, cost, contracts and patient satisfaction, enabling El Rio Health to make data-driven decisions.\nUnderstands El Rio Health costs to be able to target high costs opportunities to lower costs - Pharmacy / PCP / Specialist / ED / Hospitalization and regularly review payer data to remain up to date and aware of changes.\nResponsible for review and updates on Payer Attribution and methodology / Rosters / Claims data / RAF.\n\n \nRisk Stratification : \n\nAnalysis to help identify high-risk patients by analyzing data from various sources (such as claims data, electronic health records, lab results, and hospital utilization).\n\n\nPredicts patient outcome - risk stratification.\nIncludes SDOH in risk stratification.\nUnderstands current RAF scores and financial impact of increasing RAF scores.\nRAF score by provider\nMLR by provider to identify low outliers.\nCare Coordination and optimizing Resource management.\n\n \nQuality data management : \n\nAnalyzes claims / reimbursements for specific programs.\nUnderstands financial impact of QI initiative.\n\n\nAchieves operational objectives by contributing information and analysis to functional strategic plans and reviews by : \n\npreparing and completing action plans.\nimplementing production, productivity, quality, and customer-service standards.\nsupports managers and team members with completing audits, determining system improvements, and implementing change.\n\nCreates a work environment of professional practice by encouraging innovation and collaboration, actualizing human caring, eliciting commitment to excellence, demonstrating a respect for diversity.\nMaintains professional relations by facilitating open channels of communication with other organizational leaders, other departments, physicians, and ancillary personnel to promote excellence in service throughout the organization.\nContributes to organizational effectiveness by identifying short-term and long-range issues that must be addressed; providing information and commentary pertinent to deliberations, recommending options and courses of action; implementing directives. \n\n\nEstablishes strategic goals by gathering pertinent business, financial, service and operations information; identifying and evaluating trends and options, chooses a course of action, and evaluates outcomes.\nAnalyzes proposed legislation, regulations, or rule changes to determine how the organization or health care services could be impacted. \nActs as a consultant to senior leadership regarding the interpretation of program-related federal, state, and other county regulations and policies.\nProvides guidance and expert advice to management or other groups on technical, systems or process-related topics. \nPrepares executive summaries to inform leadership of the status and implementation plans of programs, services, and quality initiatives. \nAccomplishes staff results by communicating job expectations; plans, monitors, coaches, develops, and disciplines staff, as necessary.\nMaintains staff by recruiting, selecting, orienting, and training employees; provides personal growth opportunities to staff.\nCompletes operations by : \n\nOrganizing workflow to accomplish established objectives.\nDelegating responsibility\nEvaluating subordinates effectively\nImplementing productivity standards\nResolving operations problems\nMaintaining reference manuals\nAdministering necessary discipline\n\nProvides information to leadership, supervisors, co-workers, and subordinates by telephone, in written form, e-mail or in person as deemed most effective and appropriate.\nControls expenses by gathering and submitting budget information, scheduling expenditures, monitoring variances, and implementing corrective actions.\nMaintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.\nDemonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.\n\n \nMinimum Education and Experience : \n\nBachelor’s degree in finance, Analytics, Statistics, Information Systems, Public Health, or a related field from an accredited college or university.\nFive (5) years of manager level or supervisory experience in managed care contracting healthcare finance and / or revenue cycle; preferably in a value-based care environment.\n\n\nFive (5) years’ related experience in the operations of managed care contracting healthcare finance and / or revenue cycle. \nFive (5) years’ experience with managed care or healthcare contracting and risk-based payment methodologies such as shared savings and capitation as well as experience with complex financial modeling. \n\n\nFive (5) years’ experience utilizing analytic support tools such as Power BI, SQL, Relevant, and VBA.\n\n \nIf applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.\n \nRequired Licenses, Certifications, and Registrations : \n\nLevel I fingerprint clearance card : current valid and in good standing or have applied for it within seven working days after beginning employment.\nEmployees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must be in compliance with Arizona vehicle insurance requirements.\n\nPreferred Education, Experience, Skills, Abilities : \n\nMaster’s degree in finance, Analytics, Statistics, Information Systems, Public Health, Health Administration or a related field from an accredited college or university. \nSeven (7) years of manager level or supervisory experience in managed care contracting healthcare finance and / or revenue cycle; preferably in a value-based care environment.\n\n\nSeven (7) years’ related experience in the operations of managed care contracting healthcare finance and / or revenue cycle. \nSeven (7) years’ experience with managed care or healthcare contracting and risk-based payment methodologies such as shared savings and capitation as well as experience with complex financial modeling. \n\n\nSeven (7) years’ experience utilizing analytic support tools such as Power BI, SQL, Relevant, and VBA.\nBilingual (English / Spanish) with the ability to speak, read and write in both languages.\n\n \nEl Rio Health is a diverse and inclusive organization. We are invested in helping you and your family Create Tomorrow.\n \n