- Managed Care (Full-Time, Day Shift) -
Our mission is to participate in Jesus Christ's ministry, bringing health, healing, and wholeness to humanity by creating a supportive faculty practice framework that allows Loma Linda University School of Medicine physicians and surgeons to educate, conduct research, and deliver quality health care with optimum efficiency. We aim to deploy a motivated and competent workforce trained in customer service and whole person care principles and provide safe, seamless, and satisfying health care encounters for patients while upholding the highest standards of fiscal integrity and clinical ethics. Our core values are compassion, integrity, humility, excellence, justice, teamwork, and wholeness.
The Performance Analyst supports Managed Care leadership by providing data management and analytics related to the management of the Medicare Advantage and commercial populations and associated contract performance. This role provides the foundation for data-driven recommendations and decision-making by executive leadership teams through the design and implementation of metrics aimed at operational and financial performance, with preparation of effective data display and dashboards. Responsibilities include tracking and updating RAF/Risk Adjustment scores, forecasting for both clinical and financial data impact, and ensuring compliance with CMS and DMHC regulations as well as health plan contractual requirements for reporting. Performs other duties as assigned.
Minimum Requirements:
- Bachelor's Degree in business, health care analytics, or related discipline required.
- Minimum four years of experience in managed care data analytics and/or management required. Four additional years of experience required in lieu of degree.
Understanding of managed care data analytics is required, including capitation and sub-capitation, utilization management, claims, case management, financial analysis, and HCC coding, as well as knowledge of CMS (federal) and DMHC (state) regulations. Ability to apply performance improvement (PI) methodologies is highly desirable. Proficiency is required in data management skills, MS Excel, report and graphics development, and application of various analytics platforms. Candidates must be able to keyboard 40 wpm and use a computer, printer, and software programs necessary for the position (e.g., Word, Excel, Outlook, PowerPoint). Must be able to operate/troubleshoot basic office equipment required for the position. Candidates should be able to work calmly and respond courteously under pressure; collaborate and accept direction; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem-solve; recall information with accuracy; pay close attention to detail; and work independently with minimal supervision. Candidates must be able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace; and see adequately to read computer screens and written documents necessary for the position.
Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork, and wholeness.
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