[Remote] Manager, Clinical & Business Insight

Note: The job is a remote job and is open to candidates in USA. TriWest Healthcare Alliance is dedicated to serving America’s heroes by connecting them to healthcare in the community. The Manager of Clinical & Business Insight will oversee healthcare data reporting, analysis, and a team of analysts to provide insights that enhance operational performance and cost management within the healthcare system.ResponsibilitiesAct as an internal consultant to work across key stakeholders to gather data, perform analysis, and provide recommendations and insights to business leadersUtilize coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue) to conduct clinical analysis and facilitate improved health outcomesExecute business reporting functions, metric creation and reports that demonstrably drive operational actions and highlight wins / opportunitiesInterpret claim data using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data miningDrive improvements in cost efficiency, quality of clinical care, and effectiveness of clinical programs by performing data analysis to deliver actionable insights that are backed by empirical evidenceDevelop optimization analysis to determine how well TriWest's network meets the needs of the Government based on authorization/claims patterns, discounts achieved and access to care requirementsCollect, compile, and analyze healthcare cost and discount trends, and identify opportunities for improving/maintaining discounts based on utilization patternsCollaborate with others in Data Management and IT to enhance the data warehouse to include translating technical and functional requirements into meaningful information and improve healthcare reporting capabilityTrain department staff on healthcare data querying, terminology, integrity, standards, and proceduresCoach and mentor staff toward operational excellence and skill developmentWork with management to understand and interpret the impact of decisions made by retrieving and analyzing claims costs, authorizations and/or other relevant data. Work closely with various groups in the assembling of data, development and application of quantitative analysis and mathematical models for internal and regulatory reporting requirementsSupport Government reporting requirements, management and the medical management system by managing automated reportsDevelop methods for consistency and validity and review the accuracy of data and reports. Determine the best approach for presenting data in an efficient and beneficial mannerPreparation of annual performance evaluations and development plans for assigned staffPerform other duties as assignedRegular and reliable attendance is requiredSkillsUS Citizenship REQUIRED: Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this positionBachelor's degree in Business Administration, Healthcare, Statistics, Information Management, CIS or related field or equivalent experience5+ years of data analysis and reporting experience in the health care or insurance industry3+ years experience leading/managing reporting and analytics teamsAdvanced knowledge of Business Intelligence tools (e.g. Tableau, SSRS)Excellent verbal and written communication skills and an ability to synthesize and present results in a clear and concise mannerDemonstrated proficiency in the use of computer systems, spreadsheet applications, and data analysis software such as SQL query language, MS Excel and MS AccessFamiliar with coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue)3+ years working with medical, pharmacy and ancillary claims data, membership data or other healthcare data3+ years developing clinical measures and analyzing healthcare outcomes1 year of experience with advanced analytics tools (e.g. SAS, SPSS, R)Masters degree in Business Administration, Statistics, Public Health or other applicable disciplineExperience with VA healthcare, military health services system, and private Managed Care programsBenefitsMedical, Dental and Vision CoveragePaid time off401(k) Retirement Savings Plan (with matching)Short-term and long-term disability, basic life, and accidental death and dismemberment insuranceTuition reimbursementPaid volunteer timeFrequent pay raisesOvertime opportunities to earn even moreRecognition and reward programsCompany OverviewTriWest Healthcare Alliance - Serving Those Who Serve. At TriWest, we honor the sacrifice and service of our nations military families by It was founded in 1996, and is headquartered in Phoenix, Arizona, USA, with a workforce of 1001-5000 employees. Its website is http://triwest.com.