Trend Lead Clinical Analytics Strategy Medical Cost Opportunity amp Gaps in Care Identification

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Job Information
Humana
Trend Lead, Clinical Analytics Strategy, Medical Cost Opportunity & Gaps in Care Identification
in
Glen Allen
Virginia
Description
The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
Location:
Remote
As a Trend Lead, you will help to define a clinical data strategy to solve complex business problems using both quantitative and qualitative data from internal and external sources to provide timely insight to decision-makers. This position requires an in-depth understanding of Humana internal partner business priorities, strategy and operations, and how organization capabilities interrelate across the function or segment. In this role, you will work with various partners in the clinical organization to lead analyses, guide financial modeling, and generate actionable clinical trend insights. The Trend Lead will work closely with the Healthcare Operations organization to deeply understand business priorities and define a proactive strategy to study and identify trend and savings opportunities. This role will also work closely with the Director of Clinical Trend to have input into our Appropriate Care strategy focused on reducing overuse and waste, while encouraging high value care.
Responsibilities
The Trend Lead must be able to define an innovative data and clinical analytics strategy to meet the medical cost opportunity identification needs of the Healthcare Operations organization. This Trend Lead will need to deeply integrate with the partner organizations and understand their business priorities to create a relevant data strategy. Strong leadership through influence will be necessary to ensure the data strategy is executed to identify new and enhanced utilization management (UM), medical cost management and care management (CM) opportunities to drive savings.
Responsibilities include:
Development of analytics protocols to generate the actionable business insights that enable a pipeline of medical cost opportunities that will positively impact Humana's medical trend including member experience, health outcomes and costs.
In partnership with data scientists, define Humana's benchmarking data strategy for both commercial and Medicare Advantage lines of business, including input into the identification of appropriate external data sources and benchmarking methodology, identification of what and how healthcare services should be benchmarked, and subsequent prioritization of investigations.
Lead drivers and root cause analysis of prioritized investigations using analytics, research, methodological and clinical acumen to identify actionable clinical management or utilization management opportunities.
Collaborate with operational partners, particularly Humana Healthcare Operations organization, to define the clinical trend exploration data strategy and execute on defined strategy, with a focus on optimizing Humana's utilization management.
Collaborate with operational partners to identify levers to address identified medical cost opportunities.
Provide input into the enterprise Appropriate Care strategy and the development of new measures and methodologies to identify healthcare resource waste and drive improved clinical outcomes.
Lead opportunity value assessment, forecasting the savings of a strategy through rigorous clinical assumptions and financial metrics.
Monitor relevant publicly available news and reports in the healthcare industry, performing any ad hoc analyses and horizon scanning as needed.
Produce high quality presentations and reports to be shared with senior leadership
Role Essentials
Bachelors degree
7 or more years of strategy, healthcare, consulting and/or analytics experience
3 years' experience in strategic business role with a payer or healthcare consulting firm role or similar
3 years' of experience in guiding analytics/studies and analyzing data to generate insights
Knowledge of healthcare data
Familiarity with various clinical terminologies and classifications (e.g., ICD10, CPT, HCPCS, DRG, CCSR, GPI)
Demonstrated ability to direct clinical analytics/trend investigations (must be able to direct analytics protocols/study design, define methodology and data elements in collaboration with data scientists)
Demonstrated ability to define and lead large cross-organizational initiatives
Demonstrated ability to anticipate and be proactive around next steps within large initiatives simultaneously
Demonstrated ability to lead through ambiguity and function independently
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
High learning acuity and ability to navigate rapidly changing situations and business priorities
Role Desirables
Advanced degree (Master's or Doctorate) in business or a quantitative field (MBA, MBA with business analytics, public health, epidemiology, clinical informatics, data/healthcare consulting, actuarial science or similar may be considered)
Prior healthcare management consulting or project lead experience with large US-based consulting firm
Knowledge of utilization and/or medical claims cost management processes (prior authorization, provider payment integrity, audit, waste and abuse, etc)
Experience with medical cost opportunity and gaps in care identification
Clinical degree (MD, DO, PharmD, APRN, PA, BSN, RN, clinical informatics) or experience working with clinical data and/or clinicians, with evidence of deep understanding of healthcare data and health-systems operations
Trend and trend forecasting experience
Experience with healthcare claims data sets
Experience deriving insights from pharmacy and medical benchmarking data
Knowledge of Humana's internal policies, procedures and systems
Basic understanding of data exploration and visualization tools like python, SAS, PowerBI etc.
Additional Information
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination OR
Commit to weekly testing, following all CDC protocols, OR
Provide documentation for a medical or religious exemption consideration.
This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work. ​​​​​​​
Scheduled Weekly Hours
40

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