Medical Management Project and Analytics Manager 8/14/2016
BMC HealthNet Plan
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The Medical Management Project and Analytics Manager functions in a key role related to the implementation of new medical management initiatives, the evaluation of existing medical management activities, the evaluation of medical management business processes, and contributing to development of a best in class UM program. The Medical Management Projects and Analytics Manager, in collaboration with department leadership evaluates, designs, develops, and interprets cost and use of services reports with a particular focus on trends and patterns and identifies opportunities for improvement. Works with Senior Process Engineer to design and meet reporting needs related to UM regulatory reporting. This position works in close partnership with medical management functional department leaders as well as the Clinical Informatics team.
* Identify key milestones and delivery dates, gather stakeholders and work groups, and coordinate contributions of internal customers to support timely, successful program delivery.
* Coordinate and negotiate with other departments to assess required resources and prioritize their fulfillment based on availability and ROI
* Assist with integration of Medical Policy, UM, Pharmacy, and Care Management programs
* Work with Clinical Affairs leadership to establish the UM Committee, support Director of UM in committee oversight
* Contribute to new product implementation by developing UM polices / procedures and workflows
* Design, monitor and interpret cost, utilization and business process reporting. Works with Senior Business Engineer of specific utilization management reporting. Contribute to quality and regulatory reporting by synthesizing data and evaluations of program performance
* Collaborate with Medical Policy Program Manager and Medical Director to identify emerging technology and potentially high utilization and / or high cost services appropriate for medical policy development
* Identifies opportunities for improvement in the UM/medical management program and manages complex processes from end to end to establish feasibility, ROI, project timelines interdisciplinary support, and testing. , Coordinates major work deemed of critical importance (e.g. regulatory requests, cost savings initiatives).
* Facilitates intra-departmental, cross-departmental and cross-organizational project teams. Able to manage high visibility, complex projects.
* Design and deliver program-specific key indicators, intermediate and outcome measures
* Design and perform analyses to evaluate the effectiveness of medical management activities and programs to include tying results to specific financial or other targets. Has a keen understanding of clinical data and its implications. Collaborates with executive sponsor and/or business owner and finance to develop business case and ROI, when appropriate
* Work with business function owners to design and develop process and performance reporting
* Develops and maintains project documentation including, at minimum, a project charter, project checklist, project plan, project team directory, communication plan, risk management plan, change management plan, issues log, meeting minutes and agendas.
* Provides project status updates to senior management and other stakeholders.
* General supervision is received weekly.
Education and Licensure:
* Bachelor s or Associate s degree in Nursing or other health care field required; an equivalent combination of education, training, and experience may be considered
* Active MA Registered Nurse or other relevant professional clinical licensure
* Minimum of three years experience in a Managed Care environment required
* Two years experience in Medicaid Managed Care organization strongly preferred
* Analytic experience- comfort level with clinical data in a health/managed care environment
* Project management experience
* Enterprise risk management experience
Competencies, Skills, and Attributes:
* Demonstrated proficiency with Microsoft Office products
* Strong analytical and problem-solving skills sufficient to interpret alpha-numeric data and to identify outliers and trends
* Strong evaluative skills
* Demonstrated knowledge of health plan accountabilities and medical management approaches
* Demonstrated knowledge of health care data sets including ICD-10, CPTs, DRGs
* Ability to translate data into actionable information
* Demonstrated ability to plan, organize, and manage projects in order to meet established deadlines
* Proficient in compiling information from multiple sources
* Attention to detail with excellent proof reading and editing skills
* Ability to meet deadlines, multi-task, and problem solve in a fast-paced environment with changing priorities
* Effective communication skills (verbal and written)
* Ability to manage relationships with internal and external contacts
* Ability to work effectively both independently and within a collaborative team
* Proven ability to maintain confidentiality
* Has general knowledge of medical management systems and Utilization Management.
Working Conditions and Physical Effort:
* Work is normally performed in a typical interior/office work environment
* No or very limited physical effort required. No or very limited exposure to physical risk
* Rare travel may be required
*BMC HealthNet Plan is moving its Boston office from Copley Place to the Schrafft Center at 529 Main Street in Charlestown. The move is expected to take place by the end of 2016.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.