The Primary Care Organization (PCO), is looking for high potential candidates who are looking to accelerate their career development and contribute to driving disruption in the health care industry. The PCO provides primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. The PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.

At PCO we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

We have over 215 clinics nationwide and counting - come join us.

The Data Analytics Consultant for Medical Cost within Humana’s Primary Care Organization (PCO) is responsible for providing insights on cost, utilization, and outcomes metrics to contribute to the success of CenterWell and Conviva’s local market performance.

Responsibilities

The Role

The Data Analytics Consultant for Medical Cost will support local market operators and clinical network leadership in making data-driven strategy recommendations to bend medical cost trend thru the efficient and affordable use of specialty networks and identifying in efficient referral patterns.

Responsibilities

• Supports regional and local market leadership in the development of medical cost targets, key metrics, and projections.

• Work with various data teams and vendors to construct market level profiles on individual specialist cost and effectiveness.

• Builds strong and trusting relationships with clinical and operation dyad leaders to support problem resolution and ensure overall awareness of medical cost issues and challenges.

• Prepares ad-hoc analysis for claims and KPIs of medical costs for local leadership.

• Collaborates with PCO data teams to validate data, enhance reports and tools, and help design new products for market consumption.

• Leads trend bending initiatives focused on utilization management to help find insights in the data and works with clinical and operational stakeholders to identify opportunities to measure and improve business process effectiveness.

• Provides independent analysis and insight for specialists and the markets to constructively challenge their performance.

• Studies medical costs and use trends and contributes to the local markets efforts in reaching their medical cost and hospital utilization targets.

• Acts as project manager for all trend bender initiatives, including tracking deliverables, timelines, and holding stakeholders accountable to drive targeted outcomes.

• Interpret data and program initiative results and articulate actionable recommendations that maximize profitability and ensure trend bending targets are achieved.

• Leverages data analytics and modeling to test, validate and track return of investment of existing and proposed medical cost strategies and initiatives.

Required Qualifications:

• Bachelor’s Degree in Finance, Data Analytics, Economics, or related field

• A minimum of 3 years of related experience in a Data Analysis role focusing on medical costs and/or claims

• Experience in a Medicare Advantage, Hospital Systems and/or risk-based healthcare organization

• Ability to analyze claims data to interpret cost and utilization metrics that identifies Medicare Part A, B and D opportunities among each specialty for actionable insights

• Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise and actionable communications

• Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget

• Experience effectively identifying, developing, and implementing process improvements; to include “outside of the box” solutions

• Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels

• Ability to interpret the needs of the organization and communicate actionable insights through analytics

• Excellent verbal, interpersonal, and written communication skills

• Advanced Microsoft Excel skills including statistical modeling, vlookup and pivot tables

• Experience with SQL Query writing

Preferred Qualifications:

• Master’s Degree in Business or related field

• Experience with PowerBI

• Ability to model financial concepts of ROI, IRR, etc

• Knowledge of medical economics data such as hospital/Physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs

Additional Information:

• This is a Remote position; we would like to target candidates who reside in: TX, GA, FL, or KY. These are the preferred locations, however, we are open to candidates who reside in other states as well

• 10% to 15% monthly travel to the following specific markets: Houston, Atlanta, Florida, and/or Louisville

Work at Home Guidance:

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Schedule: Monday – Friday 8:00 AM to 5:00 PM

Alert:

Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

Interview Format: MODERN HIRE

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Please note:

Associates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

If progressed to offer, candidates will be required to:

• Provide proof of full vaccination, including booster OR
• Provide proof of applicable exemption including any required supporting documentation. Medical, religious, and state exemptions will be available

Scheduled Weekly Hours

40