Strategic Analytics Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as a subject matter expert on Medicare Risk Adjustment and reporting for at-risk providers.

• Monitor and evaluate risk adjustment activities and performance at both the provider group and Group sponsor levels.

• Collaborate with Revenue Integrity Provider Optimization and Excellence (RIPOE) to develop initiatives for provider enablement.

• Create and uphold analytical tools that support RIPOE initiatives.

• Design and implement analytical solutions utilizing GCP, AWS, Databricks, SAS, SQL, and other relevant cloud technologies.

• Construct scalable data assets and reporting frameworks by employing modern cloud data platforms and data engineering best practices.

• Develop tools for tracking membership trends, risk score trends, chronic conditions, and clinical metrics.

• Provide ad hoc analytics to assist business partners in understanding challenges and objectives.

• Aid in the creation and implementation of new health metrics.

• Generate provider-group-specific reports for Engagement Managers.

• Create and disseminate internal and external reporting as well as stakeholder communications for action plans.

• Translate business requirements into strategic projects and actionable initiatives.

• Develop and sustain MEU and financial data assets, BI tools, and cloud-based analytical solutions.

• Support at-risk provider reporting, RAPS/EDS reconciliation, Medical Cost Funds, and performance management.

• Employ business rules to pinpoint improvement opportunities in clinical coding and member engagement.

• Offer guidance on cloud data platforms, advanced analytics methodologies, and reporting solutions.

• Collaborate with technology, data engineering, and business stakeholders to establish scalable analytics capabilities and data products.

⛳️ Requirements

• Over 5 years of experience in designing and coding efficiently in SAS, SQL, Python, or a similar programming language.

• More than 5 years of experience leading the development of analytic solutions and initiatives with proven business impact.

• Familiarity with member, claim, encounter, pharmacy, or diagnosis data.

• Experience handling large datasets and addressing data challenges.

• Background in data analytics or business intelligence.

• Proficient in reporting and communication.

• Strong customer service skills.

• Capability to self-initiate, independently resolve issues, and adhere to strict deadlines.

• Ability to execute algorithms for solving business problems.

• Competence in engaging with diverse stakeholders.

• Excellent organizational skills with a keen attention to detail.

• Aptitude for learning and understanding various state rules and regulations.

• Bachelor’s degree preferred or equivalent work experience preferred.

• Experience in government-regulated healthcare programs such as Commercial, Medicare, or Medicaid is preferred.

• Familiarity with health insurance concepts and definitions is preferred.

• Risk Adjustment experience is preferred.

• Background in population health analytics is preferred.

• Previous experience in a health plan is preferred.

• Experience creating business intelligence solutions and dashboards in Tableau, AWS, or Python is preferred.

• Knowledge of risk score calculations, statistical modeling, reporting, and visualization is preferred.

• Ability to establish automated end-to-end processes is preferred.

• Sponsorship is not available.

• Candidates can reside anywhere in the US.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.