GENERAL SUMMARY
Responsible for performing in a consultative style and developing prospectively, a conceptual framework for moderately complex business and clinical modeling and performance measurement. Sets standards that are compatible with industry, regulatory and public health requirements. Has sole responsibility for some small to
medium size analytical projects.
ESSENTIAL RESPONSIBILITIES
- Uses knowledge in research and design and assists in constructing parameters in performance measurement consistent with the company’s strategic direction in medical management, marketing and sales, etc.
- Assists in translating needs, issues, and ideas into effective strategies and action plans. Coordinates team/project activities and schedules. Synthesizes analysis and identifies key findings.
- Communicates results/recommendations to project sponsors. Develops creative alternative solutions. Recommends action steps to team and client. Plans and facilitates meetings. Makes formal presentations.
- Uses application skills for decision support tool familiarity. Provides technical assistance and training to plans and other users on technical aspects and underlying concepts.
- Develops policies, procedures and guidance on data quality and standardization. This includes such tasks as reconciling relevant databases to assure consistency, tracking down data gaps and/or reviewing contract requirements.
- Develops modeling specifications for cost-effective solutions in medical management.
- Develops and refines methodology on process and outcomes measurement including HEDIS, HCFA, etc. Seeks out normative data, benchmarks, etc. for comparative purposes.
- Conducts economic and data impact analysis on proposed or new regulations especially under Medicare and Medicaid. Develops plans for data compliance and execute tasks.
- Automates production reports to streamline processes where required. Works with users to identify critical decision steps.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience. Master’s degree preferred.
- Significant experience (usually 7-10years) in clinical or marketing applications.
- Demonstrated ability to conduct and interpret quantitative/qualitative analysis.
- Demonstrated ability to navigate among economic, clinical, research and technology disciplines.
- Substantive knowledge of managed care operations. Excellent clinical knowledge and skills.
- Strong written and verbal communication skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Kansas City, MO, US
Other Locations: Franklin-Tennessee-United States,St. Louis-Missouri-United States
Organization: 10250 - Coventry Prescription Mgt Svcs
Schedule: Full-time
Job Posting: 2012-11-27 00:00:00.0
Job ID: 1212272