Clinical Strategy Analyst

Highmark Health; Northern (KY); Hybrid; USD 79,000 - 127,000; Full time

Job summary

Highmark Health seeks a Clinical Strategy Analyst to support acquisition/retention of accounts by analyzing client clinical data and preparing reporting metrics for Highmark customers. You will interpret clinical data to assess interventions, design reporting, and collaborate with strategies teams to deliver insights.

Required 5 years in clinical/managed care, RN preferred, with strong MS Office, Cognos, and analytics skills. Travel up to 25% and a Master's degree are desirable.

Qualifications

• Bachelor's degree in Nursing or clinical related field
• Master's degree preferred in Business or clinical field
• Substitutions None

Responsibilities

• Analyze client clinical data to identify trends and cost drivers.
• Prepare data analyses and deliverables representing clinical management strategies.
• Collaborate with internal teams to design reporting and insights for clients.
• Develop internal relationships across the organization and with vendors.
• Maintain and improve reporting showing analytic insights and outcomes.

Skills

Critical thinking

Clinical concepts

Microsoft Office

Cognos

Analytics Navigator

Communication skills

Business acumen

Problem solving

Decision making

Travel 0-25%

Education

Bachelor's degree in Nursing

Master's degree preferred

Tools

Cognos

Analytics Navigator

Job description

Company : Highmark Inc.

Job Description :

JOB SUMMARY

This job supports the acquisition of new accounts and retention of existing accounts by working directly with client managers within national and regional markets. The incumbent is primarily accountable for clinical analysis and preparation of reporting metric deliverables for Highmark customers, including healthcare consultants and brokers. The incumbent interprets client specific clinical data to assess clinical interventions that deliver clinical and financial results. They represent Clinical Strategy to maintain, improve and design reporting that meets the needs of the clients.

ESSENTIAL RESPONSIBILITIES

• Analyze client clinical data to determine trends and cost drivers that can be impacted by Highmark’s programs and services.
• Data set metrics include utilization and cost trends, prevalence and risk reporting, and aggregate population health management outcomes.
• Collaborate with Clinical Strategy Consultants, Health Management Strategy Consultants, Client Managers and other internal departments to prepare data analyses and deliverables that represent clinical management strategies and clinical capabilities to existing clients and potential clients.
• Develop and foster internal relationships across the organization and external vendor partners.
• Represent Clinical Strategy to maintain, improve and design reporting that demonstrate Highmark’s analytic insights, clinical capabilities, core/buy up product recommendations/outcomes and member engagement strategies.
• Research and stay current on health, wellness, productivity, risk and care management trends in the market place in order to share insights and best practices that should be illustrated in reporting/deliverables.
• Support Client Strategy Team and Client Managers for clinical related inquiries.
• Participate in internal workgroups as need, as subject matter experts.
• Responsible for identifying and completing a process improvement project at least annually in conjunction with Clinical Strategy leadership team.
• Assist by providing appropriate content and consultation to support the RFP/RFI process.
• Other duties as assigned or requested.

EDUCATION

Required Bachelor's Degree in Nursing or a clinical related field

Substitutions None

Preferred Master's Degree in Business or a clinical related field

EXPERIENCE

Required 5 years in a clinical or managed care setting To Include: 3 years of analyzing clinical outcome data 3 years of Project Management

Preferred 1 year designing outcome reporting and proficiency in reporting tools 1 year in a business or clinical environment with direct responsibility for applying technology

LICENSES or CERTIFICATIONS

Required None

Preferred Registered Nurse (RN)

SKILLS

Critical thinking skills

Understanding of key clinical concepts

Strong proficiency in Microsoft Office, Cognos, Analytics Navigator and other similar databases

Effective problem solving and decision making skills

Effective written and verbal communication skills

Strong business acumen

Conflict and crisis management skills

Language (Other than English): None

Travel Requirement: 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type Office-based Teaches / trains others regularly Frequently Travel regularly from the office to various work sites or from site-to-site Frequently Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never

DISCLAIMER

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

COMPLIANCE REQUIREMENT

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

PAY RANGE

Pay Range Minimum: $79,300.00 Pay Range Maximum: $127,100.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

DEMONSTRATION OF INCLUSION AND EEO

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

ACCESSIBILITY

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [e-mail]

CALIFORNIA CONSUMER PRIVACY ACT

Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.