Clinical Data Analyst
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Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.
As a Clinical Data Analyst, you will performs analysis of utilization and other clinical data to support managing medical costs and determine areas of clinical focus. Responsible for performing analysis of health care data, (ie., medical and pharmacy claims, membership files and member interaction) to evaluate the quality and level of care delivered and measure the effectiveness of UCare's services on both clinical quality and identified cost drivers. This includes evaluation of utilization review, case management, disease management and clinical compliance activities. Assists in the definition, preparation, and analysis of reports for internal and external users.
Responsibility of the position include:
- Performs analysis of utilization data to identify trends and patterns that impact the goals of Clinical Services and the organization. Analyzes the Inpatient Reports, Readmission Data, Authorization data, etc.
- Performs analysis of UCare medical management decision rules to enable management decisions regarding prior authorization, referral and notification requirements.
- Conducts targeted studies of particular services or treatments that are identified as needing further investigation.
- Collaborates with UCare's Data Analysis department to extract relevant data required for report creation and effective analysis of key clinical quality and identified cost drivers.
- Reports out to Clincal and Medical Leadership the results of analytical work in a manner that is easily understood and clearly identifies areas of focus.
- Identifies and gathers data to benchmark UCare's medical management functions against industry standards and to compare against competitor's performance.
- Provides assistance by delivering information to support various projects that include, but are not limited to, qualitly improvement, cost containment, protocol-specific performance monitoring, clinical outcomes analysis, physician resource utilization, delegation oversight and compliance and market analysis.
- Demonstrates an ability to integrate clinical, financial, cost, demographic, billing and other data from various sources when conducting analysis and preparing reports.
- Works with CCMS/Data Specialist in the development of standard and adhoc reports from CCMS that meet operational needs of the department.
- Works with the Clinical Services Director, Disease Management Manager, Medical Directors, and others to perform evaluations of program effectiveness.
- Performs analysis to determine effectiveness of screening logic in identifying "high-risk" members for case management.
- Performs literature reviews as requested related to program operations. Provides analysis and recommendations from the literature.
- Assists CLS staff in conducting analysis, identifying data sources and coordinates requests for data from Clinical Services management.
Required: Bachelors degree in health sciences research, mathematics or other field with a strong emphasis on critical thinking and program analysis. Statistic courses required.
Preferred: Master's degree or higher in business, accounting, finance or health care discipline.
Use of health care metrics with understanding of healthcare data and key concepts in the Managed Care and Disease Management industries is required. Statistical calculation and interpretation and relational database experience (MiniTab, Excel StatPack or SPSS) is required. Two years of health care industry experience and program analysis experience is also required.
Work in a health plan setting is preferred.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.