Manager of Healthcare Analytics

Job Summary:
The Manager of Delivery System Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to BMCHP’s outsourced managed care (OMC) partners. Working closely with the Chief Actuary, clinical leadership, and leaders from BMCHP’s OMC partners, the Manager will ensure the financial integrity of these partnerships by leading the development and communication of value added analytics and reporting while ensuring data quality and integrity.

Key Functions/Responsibilities:
•Maintain financial relationships with vendors responsible for managed care benefits (OMC partners). Assist with negotiations of revised and new financial terms as needed to support BMCHP growth strategy.
•Responsible for analyses to support business case for outsourcing versus insourcing and evaluating opportunities, risks, and ROI. Clearly define and calculate baseline costs for developing financial targets.
•Lead the analytics to evaluate, understand, and communicate behavioral health and pharmacy expense trends, including regression analysis.
•Assess impact on claims costs and utilization; evaluate risk sharing options. Assist in developing cost target and outsourcing objective to drive negotiations.
•Collaborate in RFP development; Ensure scope and timeliness of services clearly defined so efficiencies and savings can be achieved. Seek to leverage value-adds from the vendor that will increase efficiencies to the organization.
•Develop, maintain, and communicate key metrics and reports for each OMC partner, highlighting areas for opportunity and improvement. Drive and support initiatives that address areas of opportunity.
•Collaborate with project team structuring contract and service agreements to balance risk and reward for both parties. Ensure each relationship is managed appropriate to the scope of the engagement.
•Participate in comprehensive plans for transitioning processes to vendors and for managing vendor relationships to ensure maximum, sustainable benefits.
•Meet with vendors on a regular basis to access progress and track results. Ensure contractual obligations are being met by both parties. Ensure pricing and delivery obligations are being met. Verify invoices against contractual pricing and track audit results.
•Measure outcomes and continually evaluate the business case for outsourcing. Ensure agreed upon metrics are being met or advancing in the right direction.
•Represent Finance on vendor governance team.
•Lead financial audits.
•Keep internal stakeholders apprised of issues, opportunities and successes. Document results related to key vendors and share status with all stakeholders on a monthly/quarterly basis. Continue to evaluate the business case for outsourcing.
•Attract, retain, and develop talent that distinguishes BMCHP’s culture and analytic capabilities

Qualifications:

Education:
•Bachelor’s Degree in Finance, Health Care Administration, or related field required.
•Master’s Degree preferred.
•FSA/ASA preferred but not required.

Experience:
•Five (5) + years progressively responsible experience in health care financial forecasting and pricing required.
•Two (2) + years of prior experience managing a small team of analysts.

Competencies, Skills, and Attributes:
•Expert analyst with an ability to translate findings into real world solutions.
•Ability to use well developed interpersonal skills to direct and influence the efforts of others, both internally and externally.
•Ability to conceptualize and envision the impact of change, and propose new ways to do business.
•Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
•Strong communications skills, both verbal and written, are required.
•Strong understanding of health care data and analytical methodologies.
•Strong team player.
•Effective collaborative and proven process improvement skills.

Position Description »