Responsibilities Design and execute quantitative and qualitative analyses to enable measurement of efficiency and effectiveness, and improve outcomes, from programs that address the Triple Aim: lowered costs, improved quality and enhanced member engagement. Leveraging principles of program evaluation to examine effects on costs of care, utilization, clinical quality, members' experiences, and productivity. Identifying and tracking appropriate metrics to assess program processes and outcomes versus projected impacts. Examining distributions and drivers of burden of illness, health care utilization and costs both within and across populations. Collaborating with leadership from Care Management, Quality and Population Health, Provider Engagement and Contracting, Sales and other internal and external stakeholders to define, develop, evaluate and enhance member- and provider-directed programs. Synthesizing and communicating, in writing and verbally to technical and non-technical audiences, analytic results and conclusions including the business impacts of various courses of action. Applying advanced analytic and mining techniques to enhance existing or develop new clinical algorithms and/or predictive models to target program outreach, detect member and/or provider behavior patterns, and profile members and/or providers for development of effective member and provider engagement strategies. Analyzing complex healthcare data from multiple, disparate sources to identify best practices, care delivery trends and clinical practice variations. Communicating results of analyses and implications to internal and external stakeholders, including appropriately displaying results for maximum impact and effectiveness, identifying actionable improvement opportunities, writing summaries, creating presentations, and delivering results, and recommending appropriate changes to realize identified opportunities. Providing expertise regarding data availability, business intelligence (BI) tool capabilities, and appropriate use of data elements and analytic results. Tracking and prioritizing projects through coordination and negotiation with team and division leadership, and internal and external stakeholders and their representatives. Assuring all analyses and reports are reliable, valid and credible by performing quality checks of one's own work and serving as a reviewer of peers' deliverables. Informally coaching and mentoring junior team members. Assisting in the planning of initiatives to address opportunities to improve efficiency and/or effectiveness of deliverables. Serving as a subject matter expert and trusted advisor to internal and external stakeholders.
- Analyzes data, creates reports, and presents results to clients and their representatives to inform strategic decision making. Assesses population health status and illness burden, use of care, plan spend, and receipt of high-quality care consistent with evidence-based medicine guidelines. Ensures analytic results are insightful and actionable.
- Collaborates with team and department leadership and internal stakeholders to gather, document and execute analytic and reporting requirements. Explains technical details, relevance and implications of analytic results to diverse audiences. Incorporates feedback to improve content and format of deliverables. Serves as a project lead and may be dedicated to specific customers or customer segments.
- Manages multiple projects with competing deadlines. Works with team and department leadership to prioritize deliverables. Coordinates with teammates to ensure deliverables are created efficiently. Tracks work and provides regular progress updates to team and department leadership, and internal and external stakeholders.
- Contributes to development and enhancement of analytic deliverables. Actively participates in department and team meetings. Completes trainings to maintain and enhance knowledge, skills and abilities.
Education and Experience:
- Master's degree in epidemiology, biostatistics, economics, public health, healthcare administration, computational biology or a related quantitative field required;
- Two years of experience in health care consulting and/or health insurance preferred
Technical Skills and Knowledge:
- Intermediate experience and demonstrated expertise in data extraction and analytical programming languages (SAS, SQL), and data visualization tools (Tableau), and the ability to perform queries and retrieve data from multiple tables and/or sources
- Ability to perform queries, and retrieve and integrate data from multiple tables and/or sources
- Demonstrated success with analyzing clinical, claims, pharmacy, program and other administrative data
- Demonstrated knowledge, experience and success with program evaluation, including effectiveness analysis, measurement, and reporting
- In-depth knowledge and experience with population health management programs, particularly those delivered by health plans, and key factors associated with efficient and effective approaches to member and provider behavioral change
- Strong knowledge and experience with the health insurance industry and benefit and product designs
- Intermediate conceptual and hands-on knowledge of how data are captured, structured and stored
- Strong knowledge of health plan operations, data sources, and data structures, including trends and drivers of quality, utilization and costs. Comprehensive understanding of claim submissions and payment processes, reporting structures, database management, and financial concepts strongly preferred.
- Demonstrated success with communicating in writing, communicating verbally and delivering presentations
- Project management experience and expertise, a well-developed business sense, the ability to perform in a fast-paced environment, and comfort interacting with internal and external senior leaders are critical to success in the role
- Proven ability to work effectively independently, as a member of a team and/or with internal and external stakeholders with minimum guidance
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:A Great Place to Work:
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
- Business casual attire
- Competitive compensation plans
- Employee bonus program
- 401(k) with company match and an additional company contribution
- Excellent medical, dental, vision, and disability insurance
- Career development programs and classes
- Mentoring and coaching to help you advance
- Education reimbursement up to $5K per year
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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