Clinical Report Analyst, Health Plan

Sanford Health•Time, IL

1d•$29 - $47

About The Position

The clinical analyst will perform analysis of health care claims and financial data to review, analyze and compile reports and trends as it relates to designated Health Plan clients. Provide clinical insight and expertise to the account executive team and brokers for approaches needed to proactively manage the overall utilization of the client while incorporating integrated strategies to leverage appropriate resources, services, and programs. The Clinical Analyst will review integrated clinical and administrative data to support business functions and processes. Work independently to compile and conduct ongoing analysis and evaluation of claims, reports and clinical data for quality, risk, forecasting and cost impact. Follow standard practices and procedures in analyzing situations or data from which answers can be researched and obtained. Provide referrals to applicable teams, as appropriate, upon data findings. Provide clinical input to the Underwriting and Finance teams for quoting and renewing groups as well as forecasting and risk identification. Maintain a working knowledge of the data sources to accurately and efficiently report findings in a meaningful, understandable and concise manner. Establish effective mechanisms of communication with stakeholders and the organization's management team to foster an environment of openness, trust and team work. Complete special projects and management reports as assigned. Develop, analyze and monitor new, routine and ad hoc reports. Serve as a consultant with new business opportunities and plays a critical role in the annual renewal review of clients. Support Account Executives where needed on client engagement meetings, clinical review analysis and has effective presentation and communication skills. Communicate current medical management programs and cost containment strategies to assist in supporting client retention and addressing utilization trends. Collaborate with the integrated team and partners in order to provide a seamless exchange of information between internal departments including the Underwriting, Finance, Actuary, Sales and Retention, Care Management teams and brokers with the ultimate outcome to improve quality, reduce costs and enhance the client experience. Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Limited travel may be required as necessary. Demonstrate proficiency with Epic/Tapestry and Microsoft applications.

Requirements

Bachelor’s degree in nursing required.
Degree in nursing, graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Minimum of three years’ experience in the healthcare or health insurance industry required.
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.

Nice To Haves

Experience in data analytics and/or report development preferred.

Responsibilities

Perform analysis of health care claims and financial data to review, analyze and compile reports and trends as it relates to designated Health Plan clients.
Provide clinical insight and expertise to the account executive team and brokers for approaches needed to proactively manage the overall utilization of the client while incorporating integrated strategies to leverage appropriate resources, services, and programs.
Review integrated clinical and administrative data to support business functions and processes.
Work independently to compile and conduct ongoing analysis and evaluation of claims, reports and clinical data for quality, risk, forecasting and cost impact.
Follow standard practices and procedures in analyzing situations or data from which answers can be researched and obtained.
Provide referrals to applicable teams, as appropriate, upon data findings.
Provide clinical input to the Underwriting and Finance teams for quoting and renewing groups as well as forecasting and risk identification.
Maintain a working knowledge of the data sources to accurately and efficiently report findings in a meaningful, understandable and concise manner.
Establish effective mechanisms of communication with stakeholders and the organization's management team to foster an environment of openness, trust and team work.
Complete special projects and management reports as assigned.
Develop, analyze and monitor new, routine and ad hoc reports.
Serve as a consultant with new business opportunities and plays a critical role in the annual renewal review of clients.
Support Account Executives where needed on client engagement meetings, clinical review analysis and has effective presentation and communication skills.
Communicate current medical management programs and cost containment strategies to assist in supporting client retention and addressing utilization trends.
Collaborate with the integrated team and partners in order to provide a seamless exchange of information between internal departments including the Underwriting, Finance, Actuary, Sales and Retention, Care Management teams and brokers with the ultimate outcome to improve quality, reduce costs and enhance the client experience.
Ability to work independently or as a member of a team.
Ability to multitask and work with little direction.
Limited travel may be required as necessary.
Demonstrate proficiency with Epic/Tapestry and Microsoft applications.