Clinical Data Analyst
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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. CLINICAL DATA ANALYST Position DescriptionThis position is responsible to perform 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. Specific duties and responsibilities include: Perform analysis of utilization data to identify trends and patterns that impact the goals of Clinical Services and the organization. Included but not limited to analysis of inpatient reports, readmission data, authorization data, etc. Perform analysis of UCare medical management decision rules to enable management decisions regarding prior authorization, referral and notification requirements.Conduct targeted studies of particular services or treatments that are identified as needing further investigation. Collaborate with UCare's Health Economics Department to extract relevant data required for report creation and effective analysis of key clinical quality and identified cost drivers. Complete analytic reports and presents results in a clear, organized and concise manner for clinical and medical leadership that is easily understood and clearly identifies areas of focus. Identify and gather data to benchmark UCare's medical management functions against industry standards to compare against competitor's performance.Provide assistance by delivering information to support various projects that include, but are not limited to, quality improvement, cost containment, protocol-specific performance monitoring, clinical outcomes analysis, physician resource utilization, delegation oversight and compliance and market analysis.Integrate clinical, financial, cost, demographic, billing and other data from various sources when conducting analysis and preparing reports.Collaborate with clinical and operational staff in the development of standard and ad hoc reports from clinical documentation system that meet operational needs.Collaborate with the Chief Nursing Officer, Medical Directors, and others to perform evaluations of program effectiveness. Perform analysis to determine effectiveness of screening logic in identifying "high-risk" members for case management. Process and distribute routine operational reports. Supports operational and clinical reporting needs with expertise on the clinical documentation system's attributes. Manages the portfolio of operational reports, collaborating with managers and users to evaluate current reporting.Act as an administrator role for the Clinical Services clinical documentation software. This includes implementation, software enhancements, user acceptance testing, user training and troubleshooting.Participate on cross-functional teams for data, reporting, and operational decisions. Perform literature reviews as requested related to program operations. Provides analysis and recommendations from the literature. Act as an administrator role for new applications, such as HRA and predictive modeling software. This includes involvement in implementation, testing of system as needed and training material coordination. Other projects and duties as assigned.EducationBachelors degree in health sciences research, mathematics or other field with a strong emphasis on critical thinking and program analysis. Statistic courses required. Master's degree or higher in business, accounting, finance or health care discipline preferred. Required ExperienceUse of health care metrics with understanding of healthcare data and key concepts in the Managed Care and Disease Management industries. Statistical calculation and interpretation. Related database experience and experience with statistical and query software (MiniTab, Excel, MS Access, StatPack, SPSS, SQL). Two years of health care industry, program analysis and software administrator experience.Preferred ExperienceWork in a health plan setting. Experience with health care claims information.THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
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.