Remote Case Management Processor Jobs in Raleigh, NC

About The Role
The Senior Data Analyst, Clinical Programs will be an analytically driven team player, responsible for understanding business needs and objectives, eliciting requirements from stakeholders, and analyzing data and processes to identify opportunities for improvement.  This role will support BHPS Clinical Programs, Utilization Management, Complex Case Management, and Population Health Management. In this role, you will be challenged to think creatively while developing actionable insights to inform client and program strategy.
Primary Responsibilities

• Monitor Utilization Management and Case Management activities through the development of KPIs and benchmarks (i.e. member engagement rates, readmissions, preventable hospitalizations, ER utilization)  
• Develop statistical models that deliver meaningful insights on cost, utilization and clinical outcomes based on various data sources.
• Develop algorithms for stratifying populations and identifying high-risk members.
• Leverage Predictive Analytics to measure the performance (ROI) of Disease Management and other Medical Management programs.
• Conduct prospective savings analyses in support of clinical program initiatives.
• Build and maintain client-facing reports, dashboards, and analyses.
• Develop actionable data insights and advise on client strategy
•  Participate in program performance review presentations with clinical program managers, client account managers, and external clients, as needed.
• Manage internal and external client requests and timelines to ensure timely delivery.
• Collaborate with Medical Management to provide ongoing support.

Essential Qualifications

• Bachelors' degree required, preferably in Mathematics, Statistics, Finance, Actuarial Science, Data Science, or related field.
• 5-7 years of experience in healthcare analytics, preferably in a managed care setting.
• Proficiency in SQL and Microsoft SQL Server Suite of Products (SSMS) required.
• Proficiency in MS Excel required.
• Advanced data analysis, financial modeling, and predictive analytics skills.
• Experience with clinical program evaluation and outcomes reporting. 
• Experience with health plan performance reporting and cost and utilization analysis.
• Experience with developing client-facing reports.
• Experience with Business Intelligence applications and DAX functions (PowerPivot, Power BI, Tableau).
• Ability to explain technical concepts to a non-technical audience .
• Ability to effectively manage and prioritize several concurrent projects.
• Excellent oral and written communications skills.
• Experience with Payer Care Management platforms (i.e. ZeOmega) a plus.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
JOB ALERT FRAUD:  We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.  Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section.  If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com

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