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Medical Informaticist III Job
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| Employer Name: |
SpiderID: 13843836 |
| Location: San Francisco, California |
Date Posted: 9/20/2024 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17001ZY-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
A major specific focus of this position will be the development and maintenance of routine reports and ad hoc analyses for presentation to external providers as well as internal audiences. As needed, work may also focus on reporting for external employer group audiences. This scope will include both internal development and report production as well as support of reporting vendor functions. Vendor support will include ETL of company data and management of analytic logic contained in pre-ETL and ETL stages as well as vendor data processing and presentation stages. Meeting complex and time-sensitive monthly production schedules are a major component of this role. Identification and implementation of process improvements and technical inefficiencies will also be expected. Additionally, similar tasks in the employer reporting domain could assigned to this role. This role is best suited for someone who can "own" the big picture and voluminous details of their work while working collaboratively with peers and stakeholders stakeholders, and receiving broad guidance from her/his director.
Qualifications:
Cost of Health Care Analytics at Blue Shield of California supports analytic development and production reporting of cost of health care experience and emerging trends from financial, care utilization, and population health perspectives. Our aim is to provide insightful and actionable information and consultation to internal and external business and clinical stakeholders in an effort to provide a platform for the control of the cost of health care.
A major specific focus of this position will be the development and maintenance of routine reports and ad hoc analyses for presentation to external providers as well as internal audiences. As needed, work may also focus on reporting for external employer group audiences. This scope will include both internal development and report production as well as support of reporting vendor functions. Vendor support will include ETL of company data and management of analytic logic contained in pre-ETL and ETL stages as well as vendor data processing and presentation stages. Meeting complex and time-sensitive monthly production schedules are a major component of this role. Identification and implementation of process improvements and technical efficiencies will also be expected. Additionally, similar tasks in the employer reporting domain could assigned to this role. This role is best suited for someone who can "own" the big picture and voluminous details of their work while working collaboratively with peers and stakeholders, and receiving broad guidance from her/his director.
Primary responsibilities to include but not limited to:
• Develop routine reports in accordance with business unit and medical management needs and run monthly production processes on an agreed upon schedule
• Ascertain insights and identify areas of concern from monthly reports
• Summarize key analytic concepts, methodologies, and results for audiences of varying level of analytic understanding
• Communicate key findings and significance of findings to stakeholders
• Reconcile data results from different sources and combine them into integrated reports spanning cost, quality, utilization, and risk profile metrics
• Apply healthcare business knowledge and key concepts in health insurance to develop routine and ad hoc analyses
• Prioritize work and work enhancement requests while providing key deliverables to stakeholders in a timely manner
• Collaborate with junior and senior colleagues on analytic approaches
• Develop and maintain clinical databases to guide business decision making for BSC population health management, cost of health care management, quality of care, and network design and strategies.
• Function as a facilitator and mentor for analysis workgroups.
• Provide training and mentoring for team members on best practices for analysis and reporting; assists in the development of supplemental analytic training tools and materials; conduct formal training sessions for lower level analysts and analysts in other Departments.
• Consult and coordinate with analysts in other departments to reconcile analytical approaches.
• Participate on internal workgroups and committees to provide analytical insight and support for the implementation and enhancement of new programs, products, and services. This may include interactions with internal and external customers to define analytical needs and specifications.
• Work with other departments and business units to gather business requirements to design, build, and/or enhance data systems and applications that will better serve specific reporting requirements.
• Advise analysts in other departments and business units on standardization of business rules and methods for analysis and reporting.
• Design, implement, and manage complex data structures and analysis systems.
• Create system QA processes and documentation.
• Use appropriate technical, clinical, and financial knowledge to assess the completeness and reliability of data and the validity and accuracy of analytical results.
• Assess business risks associated with analytical processes and data systems and develops strategies to mitigate risks.
• Critically review and revise existing analytical processes for currency, efficiency, and sufficiency. Identifies existing inefficiencies and problems and takes action to implement solutions.
• Develop programs and processes that can be run by other lower levels analysts.
• Produce accurate work under tight deadlines
• Develop documentation and creates and executes work plans for analyses of high complexity.
• Continuously refine and expands the technical, clinical, and financial content knowledge required to successfully complete these duties.
• Requires a BA/BS in health science, quantitative social science, public health, health services research, business or math/statistics.
• Requires knowledge of healthcare data (CPT4, IDC9, etc.).
• Must have expertise with the technical, clinical, and financial concepts necessary to adequately perform the duties described above.
• Experience working with large scale health databases.
• Requires ability to use SAS or SAS EG, MS Office, esp. Excel,
• UNIX, SQL/PL-SQL with minimal supervision and support.
• Must be able to develop computer programs and scripts using Base SAS, SAS EG and ANSI SQL
• Experience with data visualization software such as Tableau or Business Objects data visualization tools.
• Experience using Python, R and Netezza desirable.
• Knowledge or experience using clinical risk adjustment, burden of illness scoring, episode analysis, and provider profiling strongly preferred.
• Certifications: SAS Certified Base Programmer Credential or equivalent strongly preferred.
• Minimum Experience Level: 3-5 years of relevant analytic experience, preferably in a health care or health insurance setting.
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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