Reporting to the Senior Business Process Engineer, the Medical Management Program Analyst (MMPA) plays a key role in the implementation of new medical management systems, the evaluation of medical management activities and business processes and the development of a best in class utilization management (UM) program. The MMPA coordinates data management activities and ensures data integrity and quality in the business systems as well as various reporting databases within the Office of Clinical Affairs (OCA).
• Consult with subject matter experts to identify information needs and outline optimal reporting formats to achieve business objectives.
• Formulate and implement validation strategies and methods to ensure accurate and reliable data.
• Create and maintain documentation, such as identified issues, summary of data, analysis, written interpretation of results, and related recommendations.
• Create and maintain a catalog of medical management program related state, federal or other regulatory reports, including specifications, frequency and submission guidelines. Monitor requirements for changes and revise reports as needed.
• Produce, at defined intervals, regulatory reports for review by applicable OCA leaders.
• Identify key milestones and delivery dates, gather stakeholders and work groups, and coordinate submissions of internal customers to support timely, successful program reporting and data analysis.
• Assist with integration of Medical Policy, UM, Pharmacy, and Care Management programs.
• Design and build cost, utilization and business process reporting that captures key performance indicators and areas of strategic enhancement. Identifies trends and opportunities for improvement.
• Identify opportunities for improvement in the UM/medical management program and manage complex processes from end to end to establish feasibility, ROI, project timelines interdisciplinary support, and testing.
• Coordinate major work deemed of critical importance (e.g. regulatory requests, cost savings initiatives) utilizing project management principles and documentation.
• Facilitate intra-departmental, cross-departmental and cross-organizational project teams.
• Manage high visibility, complex projects.
• Participate in regulatory and compliance audits as needed to provide OCA data analytic support
• Develop technical logic for analyses to evaluate the effectiveness of medical management activities and programs to include tying results to specific financial or other targets. Has a keen understanding of clinical data.
• Bachelor degree in Health Care Management, Public Health, Nursing, Information Technology/Computer Science or other health care field required
• Minimum of 3 years of experience in a managed care environment required
• 4 years of progressively responsible experience in data modeling, informatics and analysis. Commensurate educational experience in related field will be considered.
• 2 or more years of experience in Medicaid Managed Care organization strongly preferred
• Project management experience
• Experience with system integration projects including conversion, transitioning and consolidating business to new application platforms
• 3 or more years of experience as a data programmer in a relational database environment including MS Access
Competencies, Skills, and Attributes:
• Advanced Microsoft Access and SQL programming skills
• Strong analytical and problem-solving skills including but not limited to interpreting alpha-numeric data and identifying outliers and trends
• Proficiency preparing spreadsheets, graphs and other presentation materials
• Knowledge of health care data sets including ICD-10, CPTs, DRGs
• Ability to plan, organize, and manage projects in order to meet established deadlines
• Understands testing methodologies for functional, systems, integration, performance and UAT
• Proficient in compiling information from multiple sources
• Attention to detail with excellent proof reading and editing skills
• Ability to meet deadlines, multi-task, and problem solve in a fast-paced environment with changing priorities
• Effective communication skills (verbal and written)
• Ability to manage relationships with internal and external contacts
• Ability to work effectively both independently and within a collaborative team
• Proven ability to maintain confidentiality
• General knowledge of medical management systems and utilization management