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Systems Manager - Clinical Performance Monitoring

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Job Summary


 


This position will support Florida Blue Medicare, a new dynamic and innovative Medicare Advantage Company.  We apply our deep knowledge, intimate relationships, and a broad view of the health care continuum to the different consumers of Medicare Advantage health plans leveraged with the latest in technology, including artificial intelligence and omnichannel clinical member and provider interactive platforms, to empower members to partner with their health care team, which includes Florida Blue Medicare, and take charge of their healthcare.


 


This position will  help lead  effort of creating, evaluating and rapidly testing adjusting impactful and innovative digital approaches across  digital platforms to identify healthcare risk and the most appropriate actions and actors to mitigate those risks. The Member Platform: ‘My Life Plan’; The Provider Platform: My Care Community; and the Internal Care Management Platforms: Jiva & ‘Care Connect’. Under the direction of the Sr. Director, Clinical operations, Florida Blue Medicare with insight from the Sr. Medical Director of Innovation and Clinical Transformation, this role will help develop and refine rules governing tasks and triggers to reflect established priorities.  They will analyze the task trigger relationship and develop new solutions and interventions into the tasks, triggers and rules.  They will also test and operationalize new rules.  This position will require a strong background in healthcare domain, clinical systems, as well as and experience in software and IT systems. 


 


   


Essential Functions:


The essential functions listed represent the major duties of this role, additional duties may be assigned.


Oversees the analytical and clinical team for the Performance Monitoring Center (PMC)  15%


Coordinates with Enterprise IT to resolve systems issues 10%


Analyzes the effectiveness of triggers and tasks and how they are assigned to actors.15%


Develops and implements analytics to support the performance monitoring center. 15%


Oversees the reassignment of tasks to alternate actors as appropriate.10%


Develops recommendations for changes in clinical and analytic underpinning of Precision Health Management 10%


Work with Sr. Director Clinical Operations to implement program enhancements to all platforms and monitor their performance 15%


Design, develop, implement and maintain systems for data ingestion, storage, processing, and visualization under medical devise and HIPAA design controls.  10%

Required Work Experience:

  • 6+ years related work experience in healthcare data analysis including EMR/EHR claims, eligibility and publicly available data sources such as CMS, LDS, CDC, Census data, etc.


Required Management Experience:

  • 3+ years direct supervisory/management experience

  • Required Education
    Bachelor's degree required


Additional Required Qualifications: 

  • Working knowledge of healthcare data, including data from EMR/EHR and/or from medical and pharmacy administrative claims; strong preference given to those with expertise from working with claims data from multiple lines of business and payers.

  • Logical and systematic approach to problem solving, with the ability to visualize, articulate, and solve complex problems and concepts, make decisions and take appropriate actions

  • Possesses conceptual skills to learn new technologies and contribute to areas such as infrastructure, administration, and project management

  • Working knowledge of database and analytical tools including SQL and SAS or equivalents

  • Familiarity with HEDIS and CMS, Stars, RAFs, HOS, CAHPSm, care quality measures

  • Understands data model approaches to be able to discuss the pros/cons of each with our clients and data architects and create business requirements

  • Able to constantly calibrate activities to ensure effort is focused on value and not solely on technical activities, cost and schedules

  • Conceptual understanding of how hospital systems work, how they are paid by commercial carriers and government and how changing reimbursement is necessitating that hospitals and health systems be able to identify and manage risk.

  • Experience in conceptualizing analytic projects and ability to guide other analysts, providing technical leadership

  • Experience managing up and down and managing expectations. 

Preferred qualifications:

  • The preferred qualifications listed below reflect desired knowledge, skill, and/or experience.
  • Registered Nurse with Master’s degree or Certificate Health Informatics Registered Health Information Administrator (RHIA)

  • Certified Professional in Healthcare Information and Management Systems (CPHIMS)

  • Certified Professional in Health Informatics (CPHI) 


 


 


 Additional Preferred Qualifications:


 


  • Experience in the Social Determinants of Healthcare (SDH) including seeking new sources of socioeconomic, public record, biometric, and retail/consumer data, including acquisition of new SDH sources.



We are an Equal Opportunity Employer/Protected Veteran/


 


 


 


 


 


 


 

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