Director Provider Profiling

Networking

Director Provider Profiling

New York City NY

Exp 10-15 yrs

Deg Bachelors

Relo

Bonus

Occasional Travel

Job Description

 The Director, Provider Profiling will have responsibility for advancing  analytical capabilities in measuring provider and network performance in terms of quality, efficiency, and cost of care. As the healthcare industry moves beyond the current fee-for-service payment model, profiling is critical to evaluate network adequacy, to target and develop innovative value-based payment models, and to design high performing networks.  This position will oversee a team of analytical resources (both business and data analysts) who will:

•         Maintain and advance the methodology used to measure provider performance

•         Develop, in coordination with IT, an integrated data layer that consolidates and reports on provider and networking information across the domains of cost, efficiency and cost of care

•         Consult local network teams on using profiling analytics to measure provider performance, identify opportunities for value-based payer/provider partnerships (e.g., ACO, PCMH), and design high performing networks

The ideal candidate will have proven experience in managing a team of analysts to deliver consultative, analytically focused provider profiling tools and solutions to business partners.  The candidate should have deep analytical experience, knowledge of the analytical tools and methodologies used to evaluate provider performance, and proven ability to execute analytical solutions.

Essential duties to include, but are not limited to:

•         Develop standardized tools, reports and informational resources to profile our provider network in the areas of quality, efficiency, and cost performance

•         Lead the execution process of producing analytical tools and instruments for provider performance measurement (e.g. Blue Precision)

•         Provide analytical consultative support for provider contracting, payment innovation programs, product design, sales RFP/RFIs, etc.,  in the areas of network and product development strategies

•         Advocate for technical platforms to augment analytical processes and deliverables, including input into IT business requirements

•         Management of associates in the analysis of data to support the development and execution of provider performance measurement analytics

•         Experience working with other management staff and key personnel to develop strategic and tactical plans that ensure successful implementation

•         Management of large portfolio projects including direct and indirect staffing assignments

•         Management duties to include hiring, training, coaching, counseling and evaluating performance of direct reports

Qualifications:

•         Requires a BA/BS degree; Masters in Statistics, Mathematics or other related fields is highly preferred

•         8-10 years of experience in data analysis and reporting in managed care, provider reimbursement and provider performance measurement; or any combination of education and experience which would provide an equivalent background

•         Knowledge of analytical tools, statistical techniques, health care data, and provider performance assessment and analysis is required.

•         Experience with analytical tools (e.g., SAS, SQL), as well as measuring performance at the episode-level (e.g., ETGs) and population-level (e.g., ACGs, DxCGs) is required.

•         5+ years of experience in providing analytical direction to professional exempt employees is required