Overview

Your Role

The Data & Analytics (D&A) team focuses enterprise-wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data-driven solutions to accelerate business outcomes. The Medical Informatics Analyst, Principal will report to the Senior Manager, Medical Informatics (Value Based and Medical Care Solutions Analytics). In this role you will provide data, analytic, and reporting support for Medical Care Solutions, Actuarial, Network Management, and others to accelerate the achievement of business objectives. This critical analytics team collaborates with other analytical and business teams and delivers analytical insights to enhance provider partnerships and create value for our members.

Your Work

In this role, you will:

  • Conduct high-quality independent analysis of complex models in support of Accountable Care Organization (ACO) strategy and operations.
  • Develop and maintain a deep understanding of attribution parameters, logic, and related business processes.
  • Research and analyze attribution changes, explain the business and technical reasons for changes, and identify potential process or data issues.
  • Use deep understanding of utilization management, medical policy and claims data to assist operational leaders to deploy analytical solutions, strategies and interventions to improve health outcomes and reduce cost of healthcare.
  • Provide analytical support to operational leaders to monitor rhythm of the business for the respective business areas.
  • Assess business risks associated with analytical processes and data systems, and develop strategies to mitigate risks.
  • Evaluate analytic results, prepare presentation materials, and make recommendations that clearly and succinctly convey results and their business significance to appropriate audiences to inform effective decision-making.
  • Execute ACO attribution, data preparation, and reporting processes, validate results, and enhance programs to support evolving business needs.
  • Use appropriate technical, business, and financial knowledge to assess the completeness and reliability of data and the validity and accuracy of analytical results.
  • Conceptualize, design, and develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels.
  • Review, update, and enhance existing analytic processes to improve efficiencies and quality.
  • Oversee projects and provide training and mentoring for team members on best practices for analysis and reporting.
  • Produce accurate work under tight deadlines.

Your Knowledge and Experience

  • Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
  • Requires SAS Certified Base Programmer credential or equivalent and SAS Certified Advanced Programmer credential or equivalent
  • Requires at least 10 years of prior relevant experience
  • Requires at least 5 years of experience in Health Care (managed care, academic, or gov’t payer)
  • Requires demonstrated critical-thinking, analytical, and thought leadership skills
  • Requires experience in translating business problems into analytical approaches
  • Requires current working knowledge of SQL and Excel
  • Python experience preferred
  • Experience with Accountable Care Organizations strongly preferred

Pay Range:

The pay range for this role is: $ 145970.00 to $ 218900.00 for California.

Notes:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate’s experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.