Manager of Healthcare Data Analytics - Manning - Administration

Schedule: Monday - Friday

Salary: $42.85 - $62.05 depending on qualifications

JOB PURPOSE: The Manager of Healthcare Data Analytics is a key member of the Payer Relations team responsible for planning, directing, and overseeing the data analysis that supports the operations and fiscal goals around our Value Based care contracts and revenue cycle within El Rio Health. The Manager of Healthcare Data Analytics may be responsible to direct and monitor assigned staff and projects in order to accomplish El Rio Health organizational goals.

The primary goal of the El Rio Health Manager of Healthcare Data Analytics is to support El Rio’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.

Essential Job Functions:

Financial Measurements:

• Understands El Rio Health current contracts - potential earning from each based-on Quality/Shared Savings/PAF forms and dollar based on panel size.
• Collects and analyzes financial and clinical data to evaluate the effectiveness of value-based care programs.
• Tracks key performance indicators (KPIs) related to quality, cost, contracts and patient satisfaction, enabling El Rio Health to make data-driven decisions.
• Understands El Rio Health costs to be able to target high costs opportunities to lower costs - Pharmacy/PCP/Specialist/ED/Hospitalization and regularly review payer data to remain up to date and aware of changes.
• Responsible for review and updates on Payer Attribution and methodology/Rosters/Claims data/RAF.

Risk Stratification:

• Analysis to help identify high-risk patients by analyzing data from various sources (such as claims data, electronic health records, lab results, and hospital utilization).

• Predicts patient outcome - risk stratification.
• Includes SDOH in risk stratification.
• Understands current RAF scores and financial impact of increasing RAF scores.
• RAF score by provider
• MLR by provider to identify low outliers.
• Care Coordination and optimizing Resource management.

Quality data management:

• Analyzes claims/reimbursements for specific programs.
• Understands financial impact of QI initiative.

• Achieves operational objectives by contributing information and analysis to functional strategic plans and reviews by:
• preparing and completing action plans.
• implementing production, productivity, quality, and customer-service standards.
• supports managers and team members with completing audits, determining system improvements, and implementing change.
• Creates a work environment of professional practice by encouraging innovation and collaboration, actualizing human caring, eliciting commitment to excellence, demonstrating a respect for diversity.
• Maintains professional relations by facilitating open channels of communication with other organizational leaders, other departments, physicians, and ancillary personnel to promote excellence in service throughout the organization.
• Contributes to organizational effectiveness by identifying short-term and long-range issues that must be addressed; providing information and commentary pertinent to deliberations, recommending options and courses of action; implementing directives.

• Establishes strategic goals by gathering pertinent business, financial, service and operations information; identifying and evaluating trends and options, chooses a course of action, and evaluates outcomes.
• Analyzes proposed legislation, regulations, or rule changes to determine how the organization or health care services could be impacted.
• Acts as a consultant to senior leadership regarding the interpretation of program-related federal, state, and other county regulations and policies.
• Provides guidance and expert advice to management or other groups on technical, systems or process-related topics.
• Prepares executive summaries to inform leadership of the status and implementation plans of programs, services, and quality initiatives.
• Accomplishes staff results by communicating job expectations; plans, monitors, coaches, develops, and disciplines staff, as necessary.
• Maintains staff by recruiting, selecting, orienting, and training employees; provides personal growth opportunities to staff.
• Completes operations by:
• Organizing workflow to accomplish established objectives.
• Delegating responsibility
• Evaluating subordinates effectively
• Implementing productivity standards
• Resolving operations problems
• Maintaining reference manuals
• Administering necessary discipline
• Provides information to leadership, supervisors, co-workers, and subordinates by telephone, in written form, e-mail or in person as deemed most effective and appropriate.
• Controls expenses by gathering and submitting budget information, scheduling expenditures, monitoring variances, and implementing corrective actions.
• Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
• Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Minimum Education and Experience:

• Bachelor’s degree in finance, Analytics, Statistics, Information Systems, Public Health, or a related field from an accredited college or university.
• Five (5) years of manager level or supervisory experience in managed care contracting healthcare finance and/or revenue cycle; preferably in a value-based care environment.

• Five (5) years’ related experience in the operations of managed care contracting healthcare finance and/or revenue cycle.
• Five (5) years’ experience with managed care or healthcare contracting and risk-based payment methodologies such as shared savings and capitation as well as experience with complex financial modeling.

• Five (5) years’ experience utilizing analytic support tools such as Power BI, SQL, Relevant, and VBA.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations:

• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must be in compliance with Arizona vehicle insurance requirements.

Preferred Education, Experience, Skills, Abilities:

• Master’s degree in finance, Analytics, Statistics, Information Systems, Public Health, Health Administration or a related field from an accredited college or university. 
• Seven (7) years of manager level or supervisory experience in managed care contracting healthcare finance and/or revenue cycle; preferably in a value-based care environment.

• Seven (7) years’ related experience in the operations of managed care contracting healthcare finance and/or revenue cycle.
• Seven (7) years’ experience with managed care or healthcare contracting and risk-based payment methodologies such as shared savings and capitation as well as experience with complex financial modeling.

• Seven (7) years’ experience utilizing analytic support tools such as Power BI, SQL, Relevant, and VBA.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

El Rio Health is a diverse and inclusive organization. We are invested in helping you and your family Create Tomorrow.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

El Rio Health requires all employees (except those 100% working remotely) to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire.

All employees are strongly recommended to obtain COVID 19 and maintain vaccination status (i.e. as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Personnel who decline to receive COVID 19 and/or flu vaccination per most recent CDC recommendations will be recommended to wear a facemask while in an El Rio Health facility, including both clinical and non-clinical areas from November 1 to April 30 (subject to change depending on viral activity). Subject to exemptions and accommodations when required by law.

All employees are required to undergo drug testing prior to employment and, will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.