Qualifications

Bachelor’s degree in healthcare, mathematics, economics, health administration or similar field of study is required.  MBA , Master of Science in Medical Informatics, or other advanced degree preferred.
Must have a minimum of 7 years experience in health-care related and/or health plan industry with progressive responsibility in analytics to include three years middle-upper management experience.
Recent experience in healthcare quality and cost measurement with a local healthcare leader or nationally-recognized healthcare organization is required.
Must have demonstrated experience in measuring cost and quality metrics at the member or provider level using claims data and other sources of information.
Experience with information systems, claims data, groupers, risk adjustment, and working with large databases and query tools.
Must be able to communicate to various audiences the processes involved in performance measurement including drawing and communicating conclusions.
Must have an in-depth knowledge of managed care, reimbursement, coding, claims data and quality measures which demonstrates a level of knowledge equal to subject matter expert status.
Must have working knowledge of relevant software.

Accountabilities

Establishes, communicates and carries out strategic direction for the Healthcare Informatics and Measurement Department to enhance the healthcare system.
Communicates vision and direction for the technical infrastructure that supports the informatics needs of the Department in coordination with other areas of the Company and outside entities.
Leads the Informatics and Measurement Department in the design and implementation of methodologies that support physician measurement, feedback and improvement as well as quality improvement incentive reimbursement programs.
Supports the Medical Directors with regards to development of tools for clinical analysis and  Provider Services teams in matters pertaining to the  communication of programs based on analysis.
Leads  and directs staff and others on methods for identification of opportunities for healthcare system enhancement, particularly cost and quality improvement to support the strategic business needs of the company.
Effectively measures the company’s cost and quality improvement activities and their impact on the healthcare system to support corporate and provider strategies.
Ensures successful operation of the Department by selecting, managing and evaluating the departmental work activities. Develops and encourages team cohesiveness to continually improve team productivity .