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AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of the Position: This position is responsible for supporting multiple teams including Benefit Management & Pharmacy Services, Oral Health, Social Determinants of Health, and the medical Directors in the design, development, implementation, and coordination of complex data compilation and analysis that promotes and supports the AllCare BMPS department activities by performing the following duties:

• Creates and maintains detailed listings, reporting, and data visualizations to identify cost drivers and negative trends within medical, oral health, and/or pharmacy data.
• Articulates understandable explanations of complex clinical data or trends to all staff through verbal, written, and graphical presentations.
• Designs localized utilization, case, and disease management dashboards, models, and reports to support departmental staff.
• Regularly interfaces the IT Data Science team as a product owner submitting AzureDevOps Work Items (PBIs) for the development of production Data Science PowerBI Service Dashboards.

• Creates, monitors, maintains, coordinates, and submits regulatorily and contractually required contract exhibit reporting to various government entities (e.g. Exhibit I, HRSN, TOC).
• Understanding, using, and incorporating clinical data derived from CCD, CCDA, and FHIR architectures.
• Extract, Transform, and Load (ETL) data from various sources.
• Creating and using queries written with SQL/T-SQL DQL (Select) Commands in SSMS.
• Work in PowerBI Desktop using PowerBI Data Marts, Symantec Models, DAX, and Power Query to create strong data visualizations.
• Use, understand, and categorize data on various healthcare code sets such as CTP, HCPCS, ICD-9/10, and HCC.
• Support the data requirements of various MA Programs.
• Create and analyze utilization across various standardized Service Categories such as indicated by the Oregon Health Grouper (OHG) for financial and other analysis.
• Integrates data from multiple reports to evaluate AllCare member service utilization stratifying, prioritizing, and triaging high risk members for disease management and case coordination.
• Assists with collection and interpretation of risk stratification data for AllCare Medicaid and Medicare members.
• Works with department staff and IT to collect and interpret REALD & SOGI data to help identify any care gaps or barriers within our member populations.
• Assists the Benefit Management & Pharmacy Services department with assessing utilization trends to identify ways to automate prior authorization processes whenever possible.
• Runs weekly, monthly, and quarterly reports to highlight current utilization and cost data for department leadership.
• Prepares for and participates in all required DSNP training and education.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Respectfully takes direction from leadership.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned.

This position does not have any on call responsibilities.

This position does not have any supervisory responsibilities.

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care.

All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education.

Bachelor's degree in Health Informatics, Data Analytics, Computer Science, Information Systems, Public Health, Healthcare Administration, Statistics, Mathematics, Business Analytics, or a related field; or an equivalent combination of education and experience.

• Two to four years of related experience and/or training in healthcare data analysis, business intelligence, reporting, analytics, or a related field.
• Experience working with healthcare data, including claims, medical, pharmacy, oral health, utilization, or population health data.
• Experience developing reports, dashboards, and data visualizations to support business, clinical, or operational decision-making.
• Experience analyzing complex data, identifying trends, and communicating findings to technical and non-technical audiences.

• This position does not require any certificates, licenses, or registrations.

• Proficiency with SQL/T-SQL, Microsoft Power BI, and Microsoft Excel for data analysis, reporting, and visualization.
• Experience using reporting and data management tools such as SQL Server Management Studio (SSMS), Microsoft Access, Crystal Reports, and Cognos Report Studio.
• Knowledge of healthcare data structures, coding systems (CPT, HCPCS, ICD-10, HCC), and healthcare reporting requirements.
• Knowledge of healthcare data privacy standards, including HIPAA regulations.
• Familiarity with healthcare interoperability standards, including CCD, CCDA, and FHIR.
• Familiarity with healthcare programs and reporting requirements, including Medicaid, Medicare, CCO, and DSNP.
• Strong ability to analyze, interpret, and synthesize data from multiple sources to identify trends and support decision-making.
• Strong computer skills, including proficiency with Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
• Ability to identify process improvement opportunities and support implementation efforts.
• Ability to organize, prioritize, and manage multiple projects and deadlines.
• Strong written and verbal communication skills, including the ability to prepare reports and present complex information clearly.

• Demonstrates accountability, reliability, and professionalism while building trust with team members and stakeholders.
• Communicates clearly and effectively with technical and non-technical audiences, including clinical teams, leadership, and business partners.
• Collaborates effectively within a multidisciplinary and diverse team environment.
• Translates complex information into clear, understandable insights and recommendations.
• Exercises sound judgment, takes initiative, and works independently while recognizing when collaboration or guidance is needed.
• Organizes, prioritizes, and manages multiple projects, deadlines, and competing priorities.
• Adapts to changing priorities, processes, and business needs with flexibility and a willingness to learn.
• Uses critical thinking, creativity, and resourcefulness to identify solutions and improve processes.
• Maintains a high level of professionalism, confidentiality, and attention to detail when handling sensitive healthcare information.
• Builds positive working relationships through respect, accountability, and effective communication.
• Demonstrates cultural awareness and respect for diverse perspectives, experiences, and backgrounds.

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Ability to apply advanced mathematical concepts such as exponents, logarithms, quadratic equations, and permutations. Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis.

Most required work is almost exclusively on the computer, but the computer is not itself the focus of the position. Has an advanced understanding and capabilities in using applicable programs and knowledge of networks. Must be a strong reference for other users for performing different functions with the computer.

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and work with several abstract and concrete variables.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• The employee must be able to work onsite frequently.
• The employee may be able to work from a home office occasionally, as needed.
• Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.

AllCare Health Website: https://www.allcarehealth.com

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community.

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.

Monday - Friday; 8:00am - 5:00pm w/ a 1 hour unpaid lunch & two 15 minute breaks 40 hours per week