Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Medical Economics Analytics Leader

📁
Director and Equivalent
💼
EmblemHealth
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  • Lead a team to create and implement sophisticated analytics and provide support for strategic and business decision-making. 
  • Identify and address expected and unforeseen data complexities to mitigate their impact on the analytic outcome and 
  • associated business decisions. 
  • Responsible for the development of predictive analytics modeling to assist the company in effectively understanding future 
  • cost of care trend drivers and their financial and pricing impacts. 
  • Clearly communicate data issues to the recipients and work to improve data quality where possible within the analytical 
  • models you create. 
  • Ensure clear, well-organized project-specific documentation, including analytic methods used, key decision points and 
  • caveats, with sufficient detail to support comprehension and replication.

Responsibilties:

  • Responsible for root cause analysis exercises to identify potential recovery/avoidance opportunities from problems due to undiscovered system or other issues. 
  • Lead projects focused on care management, disease management and quality management optimization, working with stakeholders to identify and execute opportunities for improvement. 
  • Analyze issues using enrollment, utilization, clinical, medical management, financial and other corporate data, and information from both modeled internal data as well as disparate internal and external sources. 
  • Identify necessary data, data sources and methodologies. 
  • Responsible for the development of models that identify the causes for variation in medical costs, and the development of reports that summarize this information effectively so that appropriate actions can be taken. 
  • Develop and maintain project work plans, including critical tasks, milestones, timelines, interdependencies and contingencies. 
  • Adhere to corporate standards for performance metrics, data collection, data integrity, query design, and reporting format to ensure high quality, meaningful analytic output. 
  • Work closely with IT on the ongoing improvement, driven by strategic and business needs, and designed to ensure data and reporting consistency throughout the organization. 
  • Work collaboratively with stakeholders from across the organization to provide information, insights and business intelligence solutions that contribute to sound strategic planning, decision-making, goal setting, and effective performance measurement. 
  • Identify and understand data from internal and external sources for competitive, scenario and performance analyses, and financial modeling to gain member/provider insight into new and existing processes and business opportunities. 
  • Delegate or providing direction and feedback to staff when appropriate. 
  • Assist and teach others within the organization how to define meaningful process and performance measures, develop data queries, and generate and management reports effectively. 
  • Share development and process knowledge with analysts to ensure consistency and continuously build a core of analytical strength within the organization. 

Requirements:

  • Bachelor’s degree in Mathematics, Statistics or related degree required; Master’s degree preferred
  • 10 – 12+ years of relevant, professional work experience required
  • 7+ years of medical economics, actuarial informatics, analytics or highly impactful reporting development experience for a 
  • health provider, plan or managed care organization required
  • 3+ years’ experience in a leadership role (manager+) with a medical economics, actuarial informatics, or analytics team required
  • Working knowledge of health care EMR/claims systems (Epic/Clarity, eCW, Facets, QNXT, Amisys, etc.) required
  • Knowledge of New York State Medicaid and CMS Medicare regulations and related reporting requirements such as STARS, QARR, MMCOR, MEDS, RAPS, EDGE and HEDIS required
  • Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required
  • Strong analytical skills; ability to perform complex analysis and make recommendations based on statistical inferences required
  • Strong working knowledge of Business Intelligence products such as Tableau, Information Builders, Dimensional Insights, SAP/Business Objects, SAS, MicroStrategy, etc. preferred
  • Strong working knowledge of scripting or data mining tools like SQL, R, Python, SAS, Java/MapReduce, Aster, etc. required
  • Demonstrated ability to exercise critical thinking and logical reasoning and understand the conceptual framework and database relationships underlying health care data required
  • Excellent oral, written, presentation skills characterized by the ability to communicate effectively with varying audiences required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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