Manager Provider Analytics - 003802
Company: Univera Healthcare
Posted on: June 4, 2021
The Manager Provider Analytics oversees analytical support to
the contracting, cost savings, quality and financial strategies
which include physician and ancillary providers. The position is
also accountable for timely and quality implementation of physician
and ancillary rates including requirements, oversight and
This position includes collaborating with the Directors within
contracting, pharmacy, finance, IT, the quality office and Medical
services to support the negotiation process, reimbursement model
development, tracking financial status of negotiations with respect
to the budget and rate filings, network reporting and development,
reimbursement rate configuration/production validation and
- Leads provider analytic operations and staff through the
development, implementation, and maintenance of credible and
affordable mechanisms to analyze internal and external provider
cost/quality metrics. Creates and maintains technical solutions for
data warehousing and analysis, participates in the identification
of data requirements and specifications, determines actions to be
taken, manages workload to assure customer requirements are
fulfilled in a timely manner and with quality controls to meet
- Assigns staff to work on high level special/priority projects,
presentations, and ad-hoc provider analytic requests as requested
by management. Examples include, but are not limited to, developing
templates and models for annual contracting processes and provider
analytic support related to performance improvement programs.
- Assesses current tools and training required for all analytical
staff, makes recommendations for which tools should be used to
automate, and supports analytic functions on all teams. Develops
training programs as necessary. Accountable for assessment and
acquisition of potential tools/software to add efficiencies to
processes, procedures, and activities.
- Oversees contracting and network data sources for use in
provider negotiations, contract development, network development,
training, and analysis. This includes oversight of data
manipulation, integrity and input, balancing results with actuarial
and financial departments. Provides multiyear, cross regional
information with respect to price and network management of all
products and competitor information, benchmark measurements, and
reporting and access to information through development and
maintenance of user friendly, real time menu driven software
- Develops decision support modeling tools and leads the design,
development, ongoing maintenance and related improvement of
internal databases to assure meaningful relevant data, ease of use
and analysis, timely availability of information, and optimum
accuracy. Develops and maintains access to performance improvement
information and databases for the ongoing analysis of cost/quality
information and identification of national benchmarks and trends in
Plan network performance. Determines what data is needed and
appropriate for data modeling and provider analysis. Determines
overlaps and coordinates effort to increase staff knowledge.
Maintains templates and processes for all provider analytics and
- Works with various departments and external vendors as
necessary to combine claims history, provider cost report
information, utilization information, and competitor information
into a common contracting database. Assesses all available external
and internal source options for access to required data elements
and resulting costs and implications of acquisition, including cost
benefit analyses and implementation of work plans.
- Provides expertise to Contracting and Network services areas in
rate modeling and fee schedule preparation, training, process
development, etc. Identifies and recommends process improvement
strategies for interfaces with provider negotiations, provider
relations, operations, and other appropriate departments.
- Collaborates with the appropriate Health Care and Network
Management (HCNM) leadership to develop, implement, and maintain
provider data requirements to support the Health Plan's overarching
quality plan and network strategies. Oversees the detail data
requirements, monitors and ensures timeframes are met, and modifies
requirements as needed to reflect market changes.
- Conducts in-depth provider cost/quality analysis and ongoing
assessment to identify opportunities for improvement and provides
information for the annual evaluation. Assures statistical validity
and reliability in measuring cost/quality performance improvement
across providers. Collaborates extensively with the Medical
Directors and contracting staff to identify meaningful performance
metrics and provider-specific analytics as required.
- Supports strategy discussions with analytic to explore the
intersection of cost and quality analytics across the Plan's
provider network and potentially enhance current reporting.
Maintains current understanding of national approaches to
performance improvement and measurement, such as value-based
purchasing and alternative payment methodologies, and explore
related system requirements. Makes appropriate recommendations to
assure state-of-the-art development.
- Leads provider analytics surrounding current/future payment
models and other analyses as requested in a health reform
environment, to include global payment arrangements associated with
Accountable Care Organization development, bundled/episode based
payments and related Episode Treatment Group (ETG) analyses.
- Determines the performance measures, associated benchmarks, and
other content to include on the hospital network profile. Assures
reliability of measures and statistical methodologies in tracking
performance and related outcomes. Coordinates ongoing maintenance
and development of the hospital network profile to assure
state-of-the-art in profiling. Initiates, coordinates, and prepares
profiling of hospital network performance.
- Participates in the development and testing of a primary
care/specialty physician profile and leads provider profiling
analytics to include ongoing validation of provider crosswalk and
attribution results, contributes to the development and maintenance
of a Plan-wide attribution standard/policy, assesses cost/quality
variations in provider performance, and identifies strategies to
improve data quality overtime.
- Exhibits and maintains a high degree of knowledge relative to
physician identifier schemas, internal physician measurement
capabilities and related limitations, and leads the development of
enhanced provider analysis/profiling strategies.
- Oversees research of business and system requirements to
deliver local payment innovations and network arrangements.
Oversees research and collaborates with other Health Plans,
consultants, providers, and other health care entities to identify
availability and use of performance improvement activities,
performance incentive program enhancements, hospital and physician
profiling development, and related benchmarks.
- Oversees analysis and presentation of provider data from
performance monitoring activities. Prepares reports, graphically
displays data, and identifies outliers to share with senior
management, key network leaders, hospital CEOs, Chief Medical
Officers (CMOs) and CFOs, and committee and Board presentations.
Participates in external network meetings and committees and Boards
to present information as needed.
- Monitors reimbursement methodologies for all lines of business.
Translates reimbursement strategies of government agencies into
health plan requirements.
- Develops reimbursement configuration requirements for physician
and ancillary providers utilizing internal and external data
- Facilitates the process for implementing physician and
ancillary rates including production validation.
- Consistently demonstrates high standards of integrity by
supporting the Lifetime Healthcare Companies' mission and values
and adhering to the Corporate Code of Conduct, and Leading to the
Lifetime Way values and beliefs.
- Maintains high regard for member privacy in accordance with the
corporate privacy policies and procedures.
- Maintains knowledge of all relevant legislative and regulatory
mandates and ensures that all activities are in compliance with
- Conducts periodic staff meetings to include timely distribution
and education related to departmental and Ethics/Compliance
- Regular and reliable attendance is expected and required.
- Performs other functions as assigned by management.
- Bachelor's degree in Healthcare Field, Information Technology,
Business Administration, Finance, or similar area with a minimum of
five years business experience including modeling, financial
analysis, and/or provider analysis. In lieu of degree, a minimum of
seven years of business experience including modeling, financial
analysis, and/or provider analysis. Masters degree preferred.
- Minimum of three years in a supervisory/management
- Must have reimbursement background and some degree of physician
- Prior training experience.
- Excellent written and verbal communication skills
- Must be able to manage multiple projects concurrently.
- Must have strong project management experience and be highly
- Experience in database and software development required. Is
proficient in databases and tools utilized for both internal and
external performance monitoring.
- Previous experience in health related field required.
The Lifetime Healthcare Companies aim to attract the best talent
from diverse socioeconomic, cultural and experiential backgrounds,
to diversify our workforce and best reflect the communities we
Our mission is to foster an environment where diversity and
inclusion are explicitly recognized as fundamental parts of our
organizational culture. We believe that diversity of thought and
background drives innovation which enables us to provide
leading-edge healthcare insurance and services. With that mission
in mind, we recruit the best candidates from all communities, to
diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that
include compassion, pride, excellence, innovation and having fun!
We aim to be an employer of choice by valuing workforce diversity,
innovative thinking, employee development, and by offering
competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job
description lists only those responsibilities and qualifications
deemed essential to the position.
Equal Opportunity Employer
Keywords: Univera Healthcare, Utica , Manager Provider Analytics - 003802, Other , Utica, New York
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