Director, Clinical Analytics - Emory Health Plan
Atlanta, GA, United States
USD 125K-130K (estimate) Executive-level Full Time
Tasks
- Analyze formulary and tiering performance
- Analyze medication adherence
- Apply external benchmarking methodology
- Assess clinical outcomes in vendor ROI scorecards
- Calculate quality measures
- Characterize high cost claimants for stop loss strategy
- Conduct IBNR and reserve analyses
- Conduct member population cost stratification
- Conduct quality gap analysis
- Define and maintain clinical analytics methodologies
- Document clinical logic in dashboards and reports
- Drive vendor ROI assessment
- Identify high cost member identification
- Identify high yield care management opportunities
- Lead analytical staff and mentorship
- Lead clinical quality performance measurement
- Maintain avoidable utilization definitions
- Maintain member attribution logic
- Manage specialty and biosimilar management
- Map high cost populations to diagnosis and care gaps
- Own population health analytics function
- Perform MLR decomposition and trend attribution
- Perform longitudinal cost trajectory analysis
- Perform pharmacy analytics
- Produce prioritized opportunity matrices
- Provide inputs to benefits design financial modeling
- Reconcile PBM SLA and guarantee and rebates utilization
- Reconcile clinical performance against contractual guarantees
- Report quality measure compliance
- Track quality gate performance and utilization benchmarks
- Track quality performance trends
- Train direct reports
- Translate quality performance into financial terms
Perks/Benefits
- N/A
Skills/Tech-stack
Arcadia | Biosimilar Management | Clinical analytics | Cost Stratification | Diagnosis Coding | EHR analytics | Epic | External benchmarking | Formulary management | HEDIS | Health Analytics | IBNR Analysis | Longitudinal analysis | Loss analytics | MLR Decomposition | Medication adherence | Pharmacy analytics | Population Health | Population health analytics | Procedure Coding | Quality Measure Compliance | Quality Measurement | Rebate Reconciliation | Risk Stratification | Specialty Drug Management | Stars | Stop Loss Analytics | Stop-loss | Tiering Analytics | Trend Attribution | Utilization Benchmarking | Value-Based Care | Value-based | Vizient
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