Resp & Qualifications
The incumbent is responsible for ad hoc and standardized reporting and manipulation of large amounts of data to inform day to day decisions for Case Management as it relates to Total Care and Cost Initiative (TCCI) programs and Medical Affairs projects. In addition, supports daily workload organization and tracking and trending of key metrics and department reporting.
Under the supervision of the Senior Director and/or Managers of Complex Case Management, accountabilities include, but are not limited to, the following:
1. Gathers, analyzes, manipulates and organizes large quantities of member related care coordination data to produce standardized and ad hoc analyses and reports in support of Case Management programs, including TCCI programs, quality and cost of care, clinical outcomes, care program operations, efficiency tracking, and Case Manager performance. This includes some or all of the specific skills and functions below:
- Maintain databases and systems in accordance with priorities and scheduled target dates.
- Maintains/Revises/Troubleshoots database systems as needed to support departmental functions.
- Independently works with various departments within Medical Affairs to process, manipulate, manage, and analyze data from multiple sources to inform day to day operations, evaluate the effectiveness of program processes, and determine the clinical and cost outcomes.
- Responsible for output files for external customers, including the creating and documenting the processes relating to format, audit and validate such files. Maintain timelines and target dates for submission of data and assigned projects.
- Creates timely, accurate reports using Microsoft Office and other reporting tools
- Validates data outputs to assure accuracy. Uses critical judgment skills to quickly detect if something is askew.
- Conducts trend and forecast analysis utilizing creative judgment to determine program status. Perform qualitative and quantitative analysis relevant and appropriate to the business process being analyzed. Ask critical questions to help the leadership team see a variety of angles and options with respect to business opportunities and solutions.
- Produces ad hoc and standardized reports to meet rapidly changing business needs and priorities.
- Creates documentation and specifications which accurately and concisely outlines methodology to determine reproducibility and comparability
- Utilizes excellent analytical skills—not only to extract and manage data, but understand what the data represents, reviews critically, suggests further supplemental analysis and ensures accuracy and reasonableness of output.
- Creates status reporting mechanisms (daily, weekly, monthly, quarterly)
- Identifies trends and patterns related to wellness/illness burdens and risk strata.
- Creates, scorecards, dashboards and standardized and ad hoc reports in support of department programs and initiatives.
- Responsible for importing, transforming, validating or modeling data with the purpose of understanding or drawing conclusions from the data in order to drive clinical and operational decision-making.
- Presents data in charts, graphs and tables as well as designing and developing relational databases for collecting data.
- Creates and maintains efficient and secure systems for recording data and producing relevant documentation and reports.
2. Assists with Case Management’s daily overall workload organization along with tracking and trending of key metrics. This would include, but is not restricted to: Maintenance of cases/work queues, updating/completing required logs for internal reporting, etc.
3. Completes special projects, including being a back up to Associate Care Coordinator and Case Management Operations Specialist roles, based on business needs.
- Collaborates with other management team in the development of user documentation and training for system implementations and enhancements. Participates in the design, testing and implementation of new systems initiatives.
- Collaborates with the Management team in the creation and documentation of business process and workflow.
- Proactively identifies opportunities and enhancements.
- Use project management techniques to establish roles and responsibilities, monitor project and request status and workload, and ensure deliverables of high quality, effectiveness and timeliness.
- A Bachelor’s degree in Business, Healthcare, Information Systems, Computer Science, or a related discipline OR equivalent experience. Experience must include 2 - 4 years of analytics and business reporting experience in a healthcare or related environment.
- Additionally, this position requires demonstrated proficiency with multiple reporting applications and tools, including MS Excel (Pivot Tables & Graphing), Access, Word, Power Point, MS Project, Visio and statistical packages.
- Excellent analytical skills and critical thinking/critical reasoning skills. Must be able to interpret data, problem solve and suggest additional analyses to determine action.
- The ability to work independently and as part of a team.
- Excellent project management and organizational skills to ensure the delivery of complex work deliverables.
- Must be flexible and willing to work additional hours as necessary to complete work during critical deadlines and manage multiple projects in a fast-paced environment.
- Good oral and written communications abilities; strong interpersonal skills for customer interfacing.
- Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
- Nursing or experience in a clinical setting
- Knowledge of organization and operations of the business area supporting.
- Understands basic Internet and client/server architectures.
- Knowledge of the CareFirst Defined Processes.
- Experience with healthcare insurance industry, especially BCBS plans.
- SQL/SAS Experience
Department: Case Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 4/18/18
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship