DATA MANAGER, HEALTH PLAN SERVICES

Cook County•Chicago, IL

2d•Onsite

About The Position

The Data Manager, Health Plan Services supports the analytic needs of the department. Assists with complex data projects and reports for performance improvement initiatives, department reports, provider and provider group report cards and required reports needed for National Committee for Quality Assurance (NCQA) accreditation and Federal and State requirements.

Requirements

Bachelor's Degree from an accredited college or university in Finance, Economics, or related quantitative field with two (2) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)
OR Bachelor's Degree from an accredited college with four (4) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)
Knowledge and proficiency with SQL
Proficiency using Microsoft Office Suite including complex formulas in Microsoft Excel such as V-Lookups and Pivot Tables
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Demonstrate attention to detail, accuracy, and precision
Ability to analyze and reconcile large data sets
Ability to quickly gain a thorough understanding of the Medicaid and Medicare Managed Care
Ability to multi-task and meet deadlines in a fast paced and stressful environment
Ability to adhere to department policies and standards utilizing best practices
Ability to maintain a professional demeanor and composure when challenged
Ability to function autonomously and as a team member in a multidisciplinary team

Nice To Haves

Master’s degree in finance, Economics or related quantitative field from an accredited college or university is preferred
Knowledge of Medicaid and Medicare reporting is preferred
Knowledge of Healthcare Effectiveness Data Information Set (HEDIS) is preferred
Knowledge of Medicare STARS is preferred

Responsibilities

Utilizes a variety of data sources to obtain data for member eligibility and demographics, claims, utilization management, care management, pharmacy, provider and provider groups, surveys and Healthcare Effectiveness Data and Information Set (HEDIS).
Produces data, reports and analysis for population assessments, Utilization, Care Management, Quality, Annual Report, Centers for Medicare and Medicaid Services’ (CMS) Part C and D data validation reports, performance measures, performance improvement projects, medical cost action plans, research of programs and special tasks and projects.
Collaborates with teams including Utilization Management, Quality, Care Management, Long-term services and supports (LTSS) and Behavioral Health to identify needed data for reports.
Produces reports to determine trends and opportunities for improvement.
Participates in and contributes data as needed for performance improvement and health plan governance committees.
Provides reports for performance improvement projects and initiatives.
Creates workflows, data collection tools and data presentation formats to standardize procedures and optimize best practices for department and projects.
Provides deliverables for reports in compliance with federal, state and NCQA technical specifications and requirements.
Produces scorecards for providers and groups for quality, utilization, care management, clinical outcome data, HEDIS data STARS data.
Assists in the development of presentations for key stakeholders.
Prepares and tracks invoices and payments of vendors utilized by the Clinical team.
Performs other duties as assigned.