SUMMARY

Provide subject matter expertise and consulting in clinical analytics and population health management for employee populations, to improve health, control claims costs, support employee engagement and improve productivity. Develop and deliver strategies for both short- and long-term health improvement and cost mitigation. Stay abreast of industry and clinical trends and of vendor-and carrier-based solutions.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Analyze insurance claims data using Cotiviti’s Medical Intelligence tool to characterize employer clients’ health care utilization, trends, comparisons to norms, cost drivers and quality of care to identify opportunities for health improvement, health management and cost mitigation.
• Using analytics as well as clinical knowledge, experience and insight, and in collaboration with Wellness and Benefits Consultants, develop and present strategic plans for population health management.
• Provide clinical expertise to benefits and underwriting consultants and clients around large claims, stop loss issues, benefit plan impact, emerging medical technologies, etc.
• Oversee new program development and implementation, including development, review and scoring of RFPs for vendor partners.
• Develop new analytic approaches to more clearly identify cost and health management opportunities within client populations.
• Develop and execute program evaluations.
• Understand issues relevant to assigned clients, industry, organization and functional areas.
• Stay abreast of industry and clinical trends through literature review, benchmarking studies, conference attendance and/or proceedings and industry publications.
• Write white papers, issue briefs, presentation decks and other materials, and/or present on webinars, to support communication and results of health management programming.
• Support sales/business development efforts in collaboration with Client Executives, Health & Welfare Consulting through presentation to prospects of health management services and by developing responses to RFPs.
• Develop and maintain effective relationships with internal and external client decision makers and vendor partners.

EDUCATION AND/OR EXPERIENCE

Successful candidate will be a service-oriented individual with high personal standards and a hands-on work style. This position requires an individual who is comfortable working at a varying pace, managing multiple tasks and deadlines simultaneously, adjusting priorities often, and managing frequent interruptions.

• Degree in Nursing with active RN licensure.
• Minimum eight years’ experience in health care, population health management, health insurance, benefits administration and/or health promotion industries, with demonstrated expertise in care management, employee benefits, health insurance and/or clinical analytics.
• Strong problem solving skills, attention to detail and quality orientation.
• Ability to effectively work in a team environment
• Excellent analytical and writing skills.
• Ability to work in a fast paced, deadline-oriented environment.
• Demonstrated proficiency in basic computer applications, such as Microsoft Office software products
• Ability to travel domestically as needed.

WORK ENVIRONMENT & PHYSICAL DEMANDS

• Ability to use computer keyboard and sit in a stationary position for extended periods as well as the use of office equipment such as fax and copy machines, and telephones.
• Work is performed in a typical interior/office work environment.
• Longevity in speaking, standing or sitting to deliver presentations is required.

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The applicable base salary range for this role is $92,400 to $172,100.

The base pay offered will be determined on factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.

We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.