Pailin Group Executive Search
Associate Director of Managed Care Informatics and Data Management
Req No 2016-5475
Job Locations US-CA-Los Angeles
Category Managed Care
Type Regular Full-Time
Our premier client is seeking a full-time, Associate Director of Managed Care Informatics and Data Management to assist our Managed Care Division located in Los Angeles, California
Hours of Operations:
Monday - Friday, 8:30am-5:30pm
Under the direction of the Chief of Managed Care, the Associate Director of Managed Care Informatics and Data (ADMCID) is responsible for the direction and oversight of analytics, reporting, and research to support operational goals. The ADMCID works collaboratively with IT data management staff to assure that strategy, tactics and execution of data related processes are communicated and understood by MC operations, finance and IT staff. The Associate Director is available to consult with staff in order to assist the IT data management staff and/or finance staff with their required clinical, financial, and other data reporting responsibilities to local, state and federal agencies.
The Associate Director, Managed Care Informatics and Data role contributes to the Foundation’s success by developing management and operational reports, performing system support, analysis, and consulting on configuration, conducting data mining, and preparing data for presentation and audits, as well as working on assigned managed care projects necessary to support operational needs, grow the division, and improve the efficiency and quality of care and services delivered. This position is responsible for the management and coordination of focused projects working with Managed Care data and analytics as assigned by the Chief of Managed Care. The Associate Director, Managed Care Informatics and Data supports business strategies through the development of dashboards, reporting, and improved business and technical processes. This position requires significant capacity to manage multiple competing objectives, to prioritize, and to communicate complex information in clear and unambiguous terms to management, cross-functional team members and end user personnel.
The Associate Director, Managed Care Informatics and Data role requires an individual be independent and self-motivated and capable of developing approaches customized to meet the needs of any given request. The Associate Director, Managed Care Informatics and Data must be able to effectively lead data initiatives to improve not only the basic reporting, but also the business and technical processes involved with creating and validating reliable data. The Associate Director will need to be able to address issues by presenting analysis of issues, assessment of the results, development and implementation of long-term solutions, and presentation of fact based recommendations to key stakeholders for critical implementation decisions.
Essential Duties and Responsibilities:
- Data and Informatics Responsibilities: Associate Director, Managed Care Informatics and Data oversees and coordinates the extraction, aggregation, and quality assurance of data from multiple sources in support of performing managed care plan and Ryan White reporting, operational reporting and quantitative analyses of utilization, eligibility, quality, and claims data.
- Direct the development and execution of analytical and/or research activities to provide senior leadership with information and tools for strategic decision making and planning, health care utilization and costs, opportunities, reimbursement projects and issues, population health and clinical outcomes, provider patterns and variations, trends and forecasting, data and informatics needs, emerging technologies.
- Research, identify, & implement new approaches and methods to facilitate utilization and cost management, auditing of claims, and benchmarks for tracking project progress.
- Provide best in class reporting and analytics to monitor and improve the operational success of the Managed Care division.
- Provide leadership with reporting, analytics, and recommendations that are relevant and actionable.
- Ensure consistency of approach related to analysis techniques, key findings, and the developments of client recommendations/opportunities.
- In concert with department Directors, develop and prepare departmental scorecards & dashboards showing high-level results and trends. Provide direct skills and lead IT team in developing and preparing a consistent set of operational and program driven reports/dashboards for leadership that reflect established services standards and metrics for the Managed Care Division.
- Collaborate with IT and business units to advance the company’s reporting capabilities and improve accuracy of data.
- Research outliers and identify root causes of issues identified in reports; will require understanding of overall business.
- Maintain relationships with and provide reporting & analytical support to business units and support cross-functional projects.
- Determine opportunities and identify solutions to improve capabilities and efficiency of reporting.
- Effectively communicate workload prioritization and progress to all interested parties.
Researches applicable subject matter practices and remains abreast of industry trends, pending legislation, and impact of changes in the internal and external environment.
Infuses knowledge of industry trends into the strategic planning process and presents impact to of such trends on new or existing programs to management and staff.
Develops and maintains professional knowledge of health care delivery systems and how they relate to the Organizational enterprise, i.e., Managed Care, Ryan White and other health system contracts, regulations and accreditation requirements:
o HIV/AIDS financing structures, i.e., Medicare, Medicaid and Ryan White Care Act
o Local requirements, e.g., Ryan White Planning Council standards,
o State requirements, e.g., California Title 22 and Knox Keene Act, Florida Statute 641 health plan licensing regulations, expansion state requirements.
o Federal requirements, e.g., Code of Federal Regulations, Title 42, §417, Medicare guidance for MA-PD SNPs
o Accreditation standards, i.e., AAAHC, NCQA
o PPACA Health Reform
Serves as or uses subject matter expert(s) related to data and reporting areas being managed by the Associate Director, Managed Care Informatics and Data.
Develops internal and external presentations as well as monitoring the value and success of current or new programs.
Identifies and develops plans to address program gaps and works with Chief, Directors and Project teams to ensure that operations successfully delivers on the intended results of new and/or existing programs.
Other duties as assigned.
This position manages data systems while collaborating and directing multiple individuals across multiple disciplines during a project.
MC Staff Meetings
IT Data Meetings
Risk Adjustment Meetings
Managed Care Operations
Executive Oversight Committee
MC Director Meeting
Attends Project Management meetings for assigned work efforts
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 functions.
Education and/or Experience:
Bachelor’s degree required, Masters preferred
Experience working with SAS, SQL, DB2, and other reporting and programming languages
Experience with working with managed care enrollment and claims data
7+years in healthcare analytics/informatics and report development experience
3+ years’ experience with analytics in data warehouse environment
5+ years’ experience managing analytical teams
Experience with advanced data visualization tools a plus
Computer/Software Skills & Abilities:
To perform this job successfully, an individual has should have knowledge of Microsoft Office software in addition to understanding Microsoft SQL and DB2 and SAS programming languages.
This level of skills is necessary in order to use and create a variety of templates, complex tables, merges; manage table data, sort and filter merges, and also perform basic work with existing Macros. A person with this level of skills is able to customize toolbars, import and insert graphs, embed Excel data, and elaborate reports.
The person has the skills to
· Work with sections, create templates, use styles, and customize them.
· Create and format complex tables, and manage table data.
· Create Mail Merges, sort and filter them.
· Customize Toolbars.
· Insert graphic elements.
· Run and record Macros.
· Format documents, control page and document appearance, paginate and link table of contents.
Mail merge, generate envelopes, etc.
This level of skills is required to work with multiple worksheets; filter data, use integrate functions, and manipulate databases. With this level of skills, a person understands the concepts of databases and is able to work with charts and to use the list management capabilities of Excel.
The person has the skills to
· Operate in Visual Basic and perform complex analysis in Excel
· Develop Pivot tables and
· Create, modify, and format charts.
· Use graphic objects to enhance worksheets and charts.
· Filter data and manage a filtered list.
· Perform multiple-level sorting, use sorting options, and design considerations.
· Use mathematical, logical, statistical, and financial functions.
· Group and dissociate data and perform interactive analysis.
· Create and modify some Macro commands.
This level of skills is required to design, create, and modify databases, tables, queries, forms, and reports. A person with this level of skills understands the different database concepts and structures and is familiar with data validation and indexing techniques
The person has the skills to
· Plan, conceive, create, save, manage, and maintain a database.
· Modify a database structure.
· Generate new records and modify them.
· Create tables with Table Wizard and in Design View and work with them.
· Find, edit, filter, and sort records.
· Create and use Select Queries to view specific records and to perform calculations.
· Create, use, and customize forms, and reports.
· Work with Data Access Pages.
Intermediate & Advanced
This level of skills is required to customize templates and the PowerPoint environment, and to make a presentation interactive by using hyperlinks and action buttons.
The person has the skills to
· Create a template and work with a Design template.
· Work with graphics, animation and multimedia, inserting movies and sound.
· Work with the Office Suite to create slides from an outline and send slides to Microsoft Word.
· Customize PowerPoint toolbars and automate the slide production.
· Use AutoCorrect and the Style Checker.
· Build interactive presentations, using hyperlinks, creating interactive objects, working with Slide Show options, and using the Meeting Minder.
· Explore online meetings and broadcast presentations
This level of skill is required to develop process flow charts, organizational charts and incorporating drawings into other documents
The person has the skills to:
· Create a process flow or organizational diagram and insert it into documents
· Associate data with the shapes in the diagrams
· Develop charts that are connected and self-populate from a database.
· Import and export Word outlines or Visio diagrams into either program
This level of skill is required to conduct research, obtain data and connect with work related social networking programs.
The person has the skills to:
· Conduct data searches
· Manage internet and intranet sites
· Update MC websites
· Utilize social networking sites to expand the sphere of influence of the MC Division.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to assess situations and critically evaluate alternative problem solving to effect solutions and forward progress.
Other Skills & Abilities/Qualifications:
- Excellent organizational skills.
- Ability to work with minimal supervision.
- Sensitivity to the issues surrounding HIV and AIDS.
- Must have reliable transportation and proof of insurance.
- Must be able to work flexible hours including evenings and weekends.
- Must be able to travel locally and nationally
- Skill in communicating openly on sexual topics without prejudice or judgment.
- Strong analytical and problem-solving skills
- Ability to translate data into meaningful information in report or presentation formats
- Strong knowledge of managed care data reporting and analysis such as HEDIS, quality of care studies, benchmarking, predictive modeling and risk stratification, etc
- Ability to think strategically with appropriate level of detail analysis to plan and execute
- Ability to solve problems and drive issues or projects to conclusion
- Ability to work collaboratively across the organization
- Proactive—does not wait for things to happen—makes them happen
Well-qualified professionals please submit current resume/CV, compensation requirements along with geographical preferences in complete confidence to
Division Group Manager
Pailin Group Professional Search Consultants
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