Sanford Health je integriran sistem zdravstvenega varstva in zdravstvenega zavarovanja, ki oskrbuje skupnosti po osrednjem delu Združenih držav Amerike. S sedežem v mestu Sioux Falls v Južni Dakoti podpira več kot 1,4 milijona pacientov in skoraj 200.000 članov zdravstvenih načrtov prek obsežne mreže zdravstvenih centrov, klinik, skupnosti za starejše, zdravnikov in izvajalcev napredne zdravstvene oskrbe. Njegovo delo obsega neposredno oskrbo pacientov, zavarovanje, klinične raziskave in personalizirano genetsko medicino, s specializiranimi programi na področjih, kot so onkologija, ortopedija, zdravje žensk in genetika.
Medical Economics Analyst, Health Plan
Analyze claims, pharmacy, and healthcare cost data for Sanford Health’s rural health system. Build models and insights to support health plan performance.
Opis
- Review medical claims, pharmacy, and other healthcare data to identify cost and utilization trends, patterns, and outliers.
- Model the financial effects of clinical programs, initiatives, and value-based agreements.
- Find medical cost reduction opportunities, estimate potential savings, and assess the return on implemented initiatives.
- Build reports, dashboards, and presentations with data visualization tools.
- Share findings and practical insights with senior leaders and clinical departments.
- Work with accounting, actuarial, underwriting, clinical, health services delivery, and network management teams.
- Support decisions and strategic planning, including payer negotiations and risk adjustment strategies.
- Check the accuracy and integrity of data used in analyses.
- Document project methods and key decision points.
- Handle ad hoc data analysis requests from departments across the organization.
Zahteve
- Bachelor’s degree in economics, statistics, finance, public health, mathematics, actuarial science, data analytics, or a related quantitative field.
- One to three years of progressive analytical experience in healthcare, such as health insurance, managed care, or a health system.
- Knowledge of STARS and risk adjustment preferred.
- Strong analytical, problem-solving, critical-thinking, and communication skills.
- Proficiency with SQL for data extraction and manipulation.
- Advanced Microsoft Excel skills, including pivot tables and complex formulas.
- Experience with data visualization tools such as Tableau or Power BI is highly valued.
- Familiarity with statistical tools such as SAS, R, or Python is a plus.