Senior Health Services Researcher
0311320

Job Description

SUMMARY

The Senior Health Services Researcher assesses clinical and fiscal outcomes of healthcare programs and policies, and disseminates information to improve efficiency, effectiveness and quality of member care.  This includes recommending cost containment strategies; planning, designing, developing and writing studies using advanced statistical techniques to analyze data; employing large, relational databases to support analyses; supporting internal and external data acquisition efforts.  The incumbent is responsible for the clinical elements of provider profiling, predictive modeling and employer reporting activities.

RESPONSIBILITIES

• Minimum requirements include Bachelor’s Degree in statistics, public health, business, finance, economics and/or health administration.
• Minimum of five years successful experience in health services research, outcomes research, healthcare economics or epidemiology.
• Experience with quality studies, population-based analysis, disease management and background in research methodologies and statistics required.
• Knowledge of managed care/insurance business processes, data, systems and applications for claim payments, network and provider contract administration and management.
• Knowledge of health insurance products, benefit structures, claims coding procedure and edit logic
• Technical sophistication with relational database concepts and applications, quantitative methods and related applications (SAS) and decision support tools.
• Knowledge of NCQA, JCAHO and American Accreditation HealthCare Commission (URAC) standards.
• Ability to turn data into information, information into insights, and insights into actions.
• Ability to work independently and demonstrated strong oral, written and presentation skills.
• Demonstrated ability to drive results to completion, while managing multiple projects and priorities.

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