Healthcare Analyst III

Job Summary:

The Healthcare Analyst III is responsible for presenting analytical findings and recommendations regarding utilization to management and being proficient in identifying and quantifying opportunities to reduce medical costs within the market.

Essential Functions:

• Present analytical findings and recommendations to management
• Mentor new and developing Healthcare Analysts
• Analyze healthcare utilization to identify patterns, variation, and outliers
• Identify and quantify opportunities to reduce medical costs within the markets
• Evaluate the effectiveness of medical cost reduction initiatives
• Develop tools to efficiently compare market performance across and within products
• Provide analysis and recommendations to inform network provider performance improvement
• Monitor the efficiency and efficacy of clinical programs, interventions and processes
• Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
• Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
• Segment population data to gain holistic intelligence via longitudinal trend analyses and advanced cluster analyses
• Conduct root cause analyses of adverse population health outcomes based on demographic, socioeconomic and clinical factors
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Master's degree is preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years of experience in healthcare analytics required
• Managed care experience required

Competencies, Knowledge and Skills:

• Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
• Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required
• Proficient in with Excel, Word and PowerPoint
• Proficient with Transact-SQL or SAS or Microsoft Power BI or Tableau
• Ability to organize data in a way that facilitates inferences, conclusions and decisions
• Demonstrated written and verbal communication skills

Licensure and Certification:

• None required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.