Job Location: New York, NY
A New York City health services network is actively seeking an experienced professional to join their staff as their new Senior Lead Utilization Analyst. In this role, the Senior Lead Utilization Analyst will be responsible for driving the research and reporting of utilization, quality, and financial data to provide timely, meaningful, actionable insights to a multitude of teams within the Medical Management Department.
***This is a hybrid role requiring the qualified professional to work onsite at least 2 days a week.***
Responsibilities:
The Senior Lead Utilization Analyst will:
- Drive various designated and cross-functional reporting, using data to provide analysis and research related to the utilization, performance, and efficacy reporting of different health care services and lines of businesses under Medical Management.
- Research, collect, analyze and present of the network’s integrated utilization, quality, and financial data
- Create dashboards, report cards, and other meaningful data visualization offerings and presentations communicate actionable & timely findings to a variety of key decision makers
- Communicate and translate raw data and information between different groups
- Prepare & conduct financial related analyses on various aspects of the Medical Management and Contracting operations of the network, including utilization, payment, rate structure, and membership
- Prepare & conduct projection analyses on claims and utilization, including underlying trends and risk analysis
- Prepare analyses of medical service from large, shared databases utilizing queries and multiple level extracts
- Manage all analytical reporting requests in an assigned queue
- Facilitate process improvement within the department via program & performance evaluation.
- Provide subject matter expertise and operational support to Medical Management Department.
- Perform other duties, as needed
Qualifications:
- 5+ years of experience with progressively complex Healthcare Data Analytics / Statistical Analysis
- Bachelor’s Degree in Health Sciences, Statistics, Biostatistics, Epidemiology, Health Informatics, Health Economics, or similar field
- Health Insurance experience
- Fluent in TSQL
- Proficiency in understanding and analyzing both Professional and Facility Claims
- Solid analytical and research skills
- Great interpersonal skills
- Excellent communication skills (written and verbal)
- Strong attention to detail
- Highly organized
Desired Skills:
- Master’s Degree in Health Sciences, Statistics, Biostatistics, Epidemiology, Health Informatics, Health Economics, or similar field
- Working knowledge of Tableau or Power BI, and/or SAS/R
- Experience in performing clinical program evaluation
- Experience in utilization management, case management, and VBP arrangement
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