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POSITION PURPOSE :
This position provides analytics in understanding and improving how health care is valued, utilized and provided. This position will develop analytic and predictive models that pertain to patient level health utilization/outcome, provider performance measures, risk-adjusted revenue optimization, medical cost management, and behavior attributes on patient/provider engagement. In collaboration with other business areas and IT, this position independently provides predictive and prescriptive analytics support through machine learning and artificial intelligence technologies.
NATURE AND SCOPE :
Position Location :
This job resides in the Data & Analytics division and will report to the Manager of Data Sciences
Activities of Direct Reports :
This position has no direct reports.
Necessary Contacts :
In order to effectively fulfill this position the incumbent must be in contact with the following: Clinical Solutions, Clinical Partnerships, Care Management, Health and Quality Management, Health Value Transformation, Provider Network, Pharmacy, Actuary, Provider Reimbursement, and Actuarial, Payment Innovation, IT, Marketing, external vendors, Blue Cross Blue Shield Association and other plan BCBS plan partners.
Requires a bachelor’s degree in health care informatics, statistics, economics, mathematics, analytics, computer science, finance or other quantitative disciplines.
Four years of relevant work experience also required. Graduate degrees in related fields may be used to substitute for two (Master’s) or four (Doctorial) years of work experience.
Requires advanced understanding of statistical methodologies including big data computation and outcome research. Must be competent in using machine learning and data mining methods such as linear, logistic, and polynomial regression, support vector machines, decision trees, cluster analysis, time series analysis, unstructured data mining, ensembles and other methodologies.
Must have proficiency with commonly used database, spreadsheet, and word processing software (i.e. MS SQL Server, Teradata Studio, MS Access, MS Excel, MS Word). Proficiency in a common statistical analysis software package required (e.g. R, Python, SAS Base, SAS Enterprise Guide and SAS Enterprise Miner). Proficiency in data visualization software is required (e.g. Tableau, Power BI). Proficiency in programming language is preferred (e.g. SAS, Python, R).
Experience in developing and implementing predictive models resulting in improved outcome/processes is preferred.
Basic understanding of provider payment methodologies, population health management, and risk adjustments is required.
Basic understanding of clinical groupers including episode groupers and risk groupers such as DRB, APC, Episode Treatment Groups (ETG), Medical Episode Grouper (MEG), DxCG, and Hierarchical Condition Category (HCC) is highly desired.
Requires current knowledge of United States health care delivery system in payer setting or provider setting.
Demonstrated success in the following competencies:
Consultation, preferably as an internal consultant and demonstrated success in working with and influencing all management levels including Senior Management, Business Analyst, Business Intelligence, IT and HI Analyst/Statisticians.
Critical thinking and problem solving, preferably demonstrated project management skills, strong ability to think strategically and successfully implement solutions and skilled as a facilitator and in solution development
Collaboration, preferably in the ability to deliver results through others
Successfully leads complex project negotiations with business stakeholders and formulates recommendations for analytical strategies.
Interpersonal skills, preferably in the ability to express oneself and to build relationships.
Data analytics skills
Ability to manage multiple, competing priorities and maintain appropriate balance between business demands and priorities of the Data Analytics Division.
ACCOUNTABILITIES & ESSENTIAL FUNCTIONS :
Independently performs scientific and technical planning, analysis, reporting and methodological development. Hypothesizes, develops and organizes analytic/predictable attributes in business-impact prioritized manner.
Appropriately leverage in-house clinical reporting software. Facilitates business development, documents business problems and independently develops analytic solutions (i.e., predictive model, BI solution, or analytic attributes)
Serves as a lead analytics advisor in collaborating with departments on corporate enterprise and cross-functional projects, reports, and activities.
Develops machine learning or artificial intelligence models to predict disease progression, consumer engagement, provider performances with additional emphasis on business initiative development and execution.
The physical demands described here are representative of those that must be met by an employee to successfully perform the accountabilities (essential functions) of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
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