Data Analytics Consultant Medical Cost - Remote

Profile

Description

The Data Analytics Consultant for Medical Cost within Humana's Primary Care Organization (PCO) is responsible for providing insights on cost, utilization, and outcomes metrics to contribute to the success of Centerwell and Conviva's local market performance.

Responsibilities

About Us

The Primary Care Organization (PCO), is looking for high potential candidates who are looking to accelerate their career development and contribute to driving disruption in the health care industry. The PCO provides primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. The PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.

At PCO we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

We have over 215 clinics nationwide and counting - come join us.

The Role

The Data Analytics Consultant for Medical Cost will support local market operators and clinical network leadership in making data-driven strategy recommendations to bend medical cost trend thru the efficient and affordable use of specialty networks and identifying in efficient referral patterns.

Responsibilities

Supports regional and local market leadership in the development of medical cost targets, key metrics, and projections.

Work with various data teams and vendors to construct market level profiles on individual specialist cost and effectiveness.

Builds strong and trusting relationships with clinical and operation dyad leaders to support problem resolution and ensure overall awareness of medical cost issues and challenges.

Prepares ad-hoc analysis for claims and KPIs of medical costs for local leadership.

Collaborates with PCO data teams to validate data, enhance reports and tools, and help design new products for market consumption.

Leads trend bending initiatives focused on utilization management to help find insights in the data and works with clinical and operational stakeholders to identify opportunities to measure and improve business process effectiveness.

Provides independent analysis and insight for specialists and the markets to constructively challenge their performance.

Studies medical costs and use trends and contributes to the local markets efforts in reaching their medical cost and hospital utilization targets.

Acts as project manager for all trend bender initiatives, including tracking deliverables, timelines, and holding stakeholders accountable to drive targeted outcomes.

Interpret data and program initiative results and articulate actionable recommendations that maximize profitability and ensure trend bending targets are achieved.

Leverages data analytics and modeling to test, validate and track return of investment of existing and proposed medical cost strategies and initiatives.

Vaccine Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters.

Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Required Qualifications

Bachelor's degree in Finance, Data Analytics, Economics, or related field

A Minimum of three years of related experience in a data analysis role focusing on medical costs and/or claims

Experience in a Medicare Advantage, Hospital Systems and/or risk-based healthcare organization

Ability to analyze claims data to interpret cost and utilization metrics that identifies Medicare Part A, B and D opportunities among each specialty for actionable insights

Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise and actionable communications

Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget

Experience effectively identifying, developing, and implementing process improvements; to include 'outside of the box' solutions

Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels

Ability to interpret the needs of the organization and communicate actionable insights through analytics

Excellent verbal, interpersonal, and written communication skills

Advanced Microsoft Excel skills including statistical modeling, vlookup and pivot tables

Preferred Qualifications

Master's degree in Business or related field

Experience with PowerBI and SQL query writing

Ability to model financial concepts of ROI, IRR, etc

Knowledge of medical economics data such as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs

Additional Information

This is a remote position; we are targeting candidates who reside in: TX, GA, FL, or KY. These are preferred locations.

<25% Monthly travel to specific markets: Houston, Atlanta, Florida, and/or Louisville

Hours: 8-5 (M-F) Central or Eastern Time Zone

#LI-Remote

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com