What are the responsibilities and job description for the Manager, Data Analytics and Reporting position at Fidelis Care?
Description:
Position Purpose:
·Evaluate, design, develop and implement medical management initiatives to support the business needs through various clinical analysis
·Develop and analyze various clinical data and reports on medical management programs, including authorization, utilization and case/disease management
·Develop databases, set benchmarks, identify root cause and recommend improvements
·Develop, create and implement database or automation to support and eliminate manual updates to programs within medical management
·Research, identify and monitor provider utilization trends and monitor providers for adherence to contract provisions. Report trends and refer cases for further investigation
·Conduct audits and ensuring consistency with all contractual requirements
·Respond to all inquiries related to provider assignments
Qualifications:
Bachelor�s degree in healthcare, business, quantitative science or related field. 4+ yearsbusiness or clinical data analysis.Experience working to support the clinical services department within a healthcare system required, managed care experience is preferred. Experience with medical coding practices, groupers and reimbursement practices is preferred. Previous experience as a lead in a functional area, managing direct reports and cross functional teams on large scale projects and supervisory experience including hiring, training, assigning work and managing the performance of staff is required. Provider, medical management, and claim systems experience preferred. Knowledge of ICD-9, DRG’s and CPT codes preferred. Database management, SQL, and SAS experience required.
