Manager, Actuarial Informatics

JOB SUMMARY:

The Manager, Actuarial Informatics is responsible for a specified team of informatics analysts at the DVACO. He/she coordinates projects and manages the team informatics functions including the monitoring of cost & utilization trends, quality measure performance and network performance. This team is the key provider of data, information, and detailed analytics used to measure performance of population health initiatives and value based contracts at the DVACO. Supports other areas of the DVACO and PODs as directed by VP of Operations and the DVACO Leadership Team. Assists in maintaining a critical interdependence between the DVACO Actuarial Informatics team and the Jefferson Actuarial Informatics team. Works in collaboration with the Jefferson IT and Actuarial Informatics teams to support DVACO and POD approved initiatives. Leverages a number of cloud based and POD supported analytical applications.

ESSENTIAL ACCOUNTABILITIES:

General Leadership

  • Ability to serve department as a subject matter expert.
  • Integrates team activities with DVACO Operations and Jefferson IT and Actuarial Informatics teams to support DVACO’s goals and objectives.
  • Develops departmental and individual goals.
  • Works in collaboration with Vice Presidents, Medical Directors, Clinical Operations, Finance, Network Contracting, IT and other DVACO, Jefferson and MLH departments or stakeholders.
  • Directly supervises less experienced analysts.
  • Responsible for managing team, communicating and assigning tasks as appropriate, performing yearly performance evaluations, etc.
  • Proactively coaches and mentors others throughout DVACO.
  • Fully responsible for interpreting, organizing, executing, coordinating, evaluating, and communicating complex projects under the guidelines of leadership.
  • Communicates effectively within informal and formal channels, including written communications, presentations and informal communications with peers, management and business partners.

Analytics

  • Coordinates requests for analysis from internal and external clients including assignment, mentoring and establishing timelines.
  • Interfaces directly with customers and management to negotiate requirements (understand customer needs and provide consultation on options to best meet that need) with customers to ensure optimal value and timely delivery.
  • Provides direction and/or consultation on analytical approach to peers and customers.
  • Uses business knowledge to anticipate business questions and needs and proactively identify and implement solutions. Identifies gaps in business reporting and proactively identifies and implements solutions.
  • Assist analysts in written analytic summaries used to communicate financial performance and trend analysis to DVACO and POD audiences.
  • When required, creates written narrative summaries that compliment many of the key performance indicators and metrics, or analytics outlining trends of interest, opportunities for intervention or consideration, changes or shifts in data elements from one time period to another, etc.
  • Develops and maintains data/reporting systems that allow for ease of data retrieval and manipulation from a variety of sources including EHR, quality, claims payment, utilization management, health plan risk pools, pharmacy, lab, internal charges, and others as necessary.
  • Provides analytical support (consultation, design, analysis) to DVACO\POD clinical and financial teams to understand and monitor performance as it relates to cost and quality.
  • Works with the DVACO\POD clinical and financial teams to identify trends and patterns in these complex data sets, draw conclusions, develop summaries utilizing charts, graphs and images to appropriately display the information for presentations to stakeholders.
  • Works with and educates the POD quality leadership, the TIN and clinical practice leadership to present statistical and operational reports of the metrics including analysis of progress towards goals and benchmarks.
  • Develops financial models to assess performance of value based reimbursement arrangements.
  • Develops models to evaluate provider network and DVACO contract proposals.
  • Identifies trends and recommends methods for reducing cost/utilization.
  • Performs research on industry performance measures.
  • Demonstrates initiative including recommending changes for improvement opportunities.
  • Participates in all required meetings, educational overview sessions, product implementation and review sessions as communicated by leadership
  • Acquires knowledge about DVACO and JHS\MLH Pods system and processes, as required to support population health reporting.
  • Interacts with co-workers, visitors, and other staff consistent with DVACO values.
  • Performs other duties as required for which the employee is qualified to perform.

Primary Customers or Key Working Relationships:

  • DVACO Leadership; DVACO Operations Team; JHS and MLH Analytics Leadership\Staff; JHS, MLH and DVACO Care Coordinators; DVACO Practice Transformation Team; DVACO and POD Clinical teams; JHS IT Teams
  • Vendor leadership and project teams

QUALIFICATIONS:

Education:
Bachelor’s Degree in Mathematics, Actuarial Science, Statistics or related field required. Master’s degree preferred.

Fellowship in Society of Actuaries and Member of the American Academy of Actuaries preferred
Experience:

Minimum of 5-6 years of analysis experience related to health care or insurance. One year of experience may be granted for passage of at least one or more Society of Actuarial (SOA) exams or active in the Exam Program.
2 years of supervisory experience preferred. In-depth knowledge of managed care and medical products.

Technical Skills\Capabilities

  • Maintains proficiency and expertise in Health Plan data applications, state of the art business intelligence software and reporting tools that include, but are not limited to, MS SQL Server Components (Query Analyzer & coding, SSRS, Analysis Server, Stored Procedures, Jobs, and Functions), Business Objects (Tableau, Qlik, Crystal Reports, Crystal Enterprise, Crystal Analysis and OLAP), SAS, Microsoft Office (Word, Excel, PowerPoint, and Access) and grouper and predictive modeling software (3M and CGI) to prepare complex multi-factorial analysis. Synthesizes and Interprets analyses.
  • Must possess a comprehensive understanding of clinical or payer operational processes and ability to evaluate impacts on data compilation and reporting.
  • Knowledge of healthcare coding structures and payment methodologies.
  • Understanding of relational database systems and uses.

Other Skills\Capabilities

  • Demonstrates strong mathematical, statistical, financial, technical, interpersonal, organizational, project management skills, and ability to maintain confidentiality.
  • Demonstrated strong business acumen.
  • Effective verbal and written communication and presentation skills appropriate for communication with both external clients and senior management.
  • Demonstrated evidence of independent analytical and problem solving skills.
  • Exceptional time management and organizational skills.
  • Ability to effectively handle numerous priorities simultaneously.
  • Demonstrated ability to identify problem areas and take initiative to identify and implement appropriate solutions, self-motivated

WORKING CONDITIONS:

Position requires the ability to manage multiple tasks in a fast moving environment.

Exposures:
Individual must take proper precautions as outlined in Hospital Safety Manual, Infection Control Policy and Fire and Emergency Manual.

Please apply to http://www.mainlinehealth.org/careers job id 45320. No agency calls please. Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to Main Line Health. This will be verified during pre-employment testing.

We are an equal opportunity employer.