Summary
The Utilization Management Clinical Analyst (non IT role) plays a pivotal role in GEHA and is responsible for the clinical data mining into UM clinical data, clinical data discovery and metrics and trending analysis, development, and delivery of comprehensive clinical reports that provide actionable insights to leadership. This position requires a strong background in healthcare data analysis, a deep understanding of health plan clinical operations, and the ability to translate complex clinical data into meaningful, actionable information.
This role will help meet the executive reporting and clinical specific data reporting needs for clinical operations, specific to executive needs (CMO) and for utilization management department within GEHA. The individual will work in close partnership with Medical Management leadership to meet the needs of the Clinical Operations Division.
Duties
Data Analysis and Reporting:
- Gather, organize, analyze, and interpret clinical utilization data from various sources within GEHA.
- Develop comprehensive reports and presentations for senior leadership, identifying trends, patterns and providing insights into utilization, outcomes, and performance metrics.
Clinical Performance Assessment:
- Evaluate clinical performance indicators, identifying trends, patterns, and areas for improvement.
- Collaborate with clinical teams to understand operational challenges and opportunities for enhancement.
- Monitor benefit utilization trend for emerging risks
Analyze Dashboards and Metrics:
- Review and assess dashboards and metrics that offer real-time insights into utilization performance and outcomes to identify opportunities for cost reduction and quality improvement.
- Monitor and develop key performance indicators (KPIs) and benchmarks to track progress and support data-driven decision-making.
Collaboration with Cross-Functional Teams:
- Work closely with Data & Analytics and other GEHA departments to ensure data integrity, standardization, and accuracy.
- Collaborate with stakeholders to identify reporting requirements and implement solutions to meet their needs.
- Stay current with industry trends, best practice, and regulatory requirements related to healthcare data analytics and utilization management.
Continuous Improvement Initiatives:
- Identify areas for process improvement, efficiency, and quality enhancement within utilization management.
- Support the development and implementation of data-driven strategies to optimize healthcare utilization, enhance patient outcomes, and managed cost of care effectively.
- Recommend strategies for optimization based on data-driven insights and industry best practices.
Documentation and Presentation:
- Prepare clear and concise documentation of methodologies, findings, and recommendations.
- Deliver presentations to senior leadership, effectively communicating complex data in an understandable manner.
Education Requirements
Bachelor’s degree in healthcare management, data science, statistics, public health or a related field.
Experience Requirements
- Proven experience 3+ years in healthcare data analysis and reporting within a clinical setting or healthcare environment.
- Proficiency in data analysis tools and software (e.g., SQL, Tableau, Excel, Milliman MedInsight, etc.).
- Strong understanding of healthcare operations, claims data, and healthcare data systems.
- Excellent communication and presentation skills, with the ability to translate complex data into actionable insights to a variety of stakeholders
- Detail-oriented, with strong problem-solving and critical-thinking abilities.
- Ability to work independently and collaboratively in a team-oriented environment.
Preferred Qualifications
- Experience with machine learning and predictive modeling techniques.
- Familiarity with population health management and value-based care initiatives.
- Proven experience 3+ years in health plan utilization management data analysis and reporting
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
