Clinical Data Analysis Lead

Job Locations US-RI-Smithfield
Req No.
2018-8264
Department
Analytics
Type
Regular Full-Time

Overview

This position is the primary point of contact for Medical Management (MM) Medicare-Medicaid (MMP) Systems processes and Clinical Data reporting. He/she works directly with business units and external entities to ensure compliance and accuracy rates for EOHHS and CMS MM MMP data submissions. He/she will understand business operations, product and contractual requirements, business workflows, and a variety of systems and data repositories to support/monitor business operations to ensure that all resources are being used effectively; and actively participate in identifying current problems and future needs of the department. He/she must be self-directed and solution oriented. He/she will provide data analysis, analytical and systems support. He/she works collaboratively with Information Technology, Analysis, Product, Provider Engagement & Contracting, and other departments to assist in the development of requirement documents, business cases and business plans.

Responsibilities

  • Understands Medicare-Medicaid Plan (MMP) business operations, product and contractual requirements, business workflows, data, and a variety of systems and data repositories to identify relevant data to monitor Medical Management business operations
  • Coordinates MMP information from multiple data sources; assures timely delivery of reports and analysis requests; and performs quality assurance data review
  • Analyze MMP data, as well as highlighting, presenting and making recommendations regarding key findings to Medical Management Leadership
  • Ensures that Clinical Data systems capture the data necessary for Medical Management MMP reporting to CMS, DOH and EOHHS
  • Medical Management point person for systems implementation and upgrades related to MMP deliverables
  • Supports managers in the development and maintenance of regulatory-compliant policies and procedures that address NCQA standards, DOH regulations, EOHHS contract, and CMS regulations
  • Supports and provides cross-coverage for the Medical Management Clinical Data Analysis Lead
  • Other Duties as assigned
  • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications

Required:

  • Bachelor’s degree in Information Technology or Business related discipline; or sufficient years of experience and background equivalent to this degree
  • 3+ years of managed care/health care experience required
  • Database and spreadsheet proficient, including Excel
  • Experienced in the use of analytical tools, such as Cognos
  • Computer literacy with windows based programs
  • Strong organizational and prioritization skills, with the ability to work independently
  • Strong interpersonal skills and proficiency in communication, with the ability to interact effectively across internal business units and with external entities
  • Strong problem solving skills and attention to detail
  • Ability to work effectively as a member of a team
  • Ability to take ownership of project/work

Preferred:

  • Experience in Cognos report writing
  • Experience with SQL Server Management Studio
  • Experience in Care Management delivery systems
  • Experience with Medicaid and/or Medicare government healthcare program regulations

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

 

Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

 

Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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