DATA MANAGER, HEALTH PLAN SERVICES

LOCATION / DEPARTMENT: HEALTH PLAN SERVICES

SHIFT: 9AM – 5PM

 This position is exempt from Career Service under the CCH Personnel Rules.

Job Summary

The Data Manager, Health Plan Services supports the analytic needs of the department.  Assists with complex data projects and reports for performance improvement initiatives, department reports, provider and provider group report cards and required reports needed for National Committee for Quality Assurance (NCQA) accreditation and Federal and State requirements.

General Administrative Responsibilities

Collective Bargaining

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals

•  Participate in collective bargaining negotiations, caucus discussions and working meetings

 Discipline

•  Document, recommend and effectuate discipline at all levels

•   Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements

•   Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures, and provision of applicable collective bargaining agreements

Supervision

•  Direct and effectuate CCH management policies and practices

• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management

•  Contribute to the management of CCH staff and CCH’ systemic development and success

• Discuss and develop CCH system policy and procedure

• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements

• Work with Labor Relations to discern past practice when necessary

Typical Duties

• Utilizes a variety of data sources to obtain data for member eligibility and demographics, claims, utilization management, care management, pharmacy, provider and provider groups, surveys and Healthcare Effectiveness Data and Information Set (HEDIS).

• Produces data, reports and analysis for population assessments, Utilization, Care Management, Quality, Annual Report, Centers for Medicare and Medicaid Services’ (CMS) Part C and D data validation reports, performance measures, performance improvement projects, medical cost action plans, research of programs and special tasks and projects.

•  Collaborates with teams including Utilization Management, Quality, Care Management, Long-term services and supports (LTSS) and Behavioral Health to identify needed data for reports.

•  Produces reports to determine trends and opportunities for improvement.

•  Participates in and contributes data as needed for performance improvement and health plan governance committees.

• Provides reports for performance improvement projects and initiatives. 

• Creates workflows, data collection tools and data presentation formats to standardize procedures and optimize best practices for department and projects.

•  Provides deliverables for reports in compliance with federal, state and NCQA technical specifications and requirements.

• Produces scorecards for providers and groups for quality, utilization, care management, clinical outcome data, HEDIS data STARS data.

• Assists in the development of presentations for key stakeholders.

• Prepares and tracks invoices and payments of vendors utilized by the Clinical team.

• Performs other duties as assigned.

Minimum Qualifications

·        Bachelor's Degree from an accredited college or university in Finance, Economics, or related quantitative field with two (2) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)

OR

Bachelor's Degree from an accredited college with four (4) years of full-time paid work experience as a Data Analyst or similar role in a hospital, healthcare, or managed care organization is required (Official transcript due at the time of interview)

Preferred Qualifications

·        Master’s degree in finance, Economics or related quantitative field from an accredited college or university is preferred

·        Knowledge of Medicaid and Medicare reporting is preferred

·        Knowledge of Healthcare Effectiveness Data Information Set (HEDIS) is preferred

·        Knowledge of Medicare STARS is preferred

Knowledge, Skills, Abilities and Other Characteristics

·        Knowledge and proficiency with SQL

·        Proficiency using Microsoft Office Suite including complex formulas in Microsoft Excel such as V-Lookups and Pivot Tables

·        Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups

Knowledge, Skills, Abilities and Other Characteristics continued

·        Demonstrate attention to detail, accuracy, and precision

·        Ability to analyze and reconcile large data sets

·        Ability to quickly gain a thorough understanding of the Medicaid and Medicare Managed Care

·        Ability to multi-task and meet deadlines in a fast paced and stressful environment

·        Ability to adhere to department policies and standards utilizing best practices

·        Ability to maintain a professional demeanor and composure when challenged

·        Ability to function autonomously and as a team member in a multidisciplinary team

Physical and Environmental Demands

This position is functioning within a healthcare environment.  The incumbent is responsible for adherence to all hospital and department specific safety requirements.  This includes but is not limited to the following policies and procedures:  complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.

For purposes of the American with Disabilities Act, “Typical Duties” are essential job functions.

VETERAN PREFERENCE

PLEASE READ

When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service.

To take advantage of this preference a Veteran must:

• Meet the minimum qualifications for the position.
• Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”
• Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of  application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list an Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.

OR

A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

If items are not attached, you will not be eligible for Veteran Preference

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW

 MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION 

BENEFITS PACKAGE:

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan and Deferred Compensation Program
• Employee Assistance Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)

 Degrees awarded outside the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.

Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.

 *CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.

 COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER