Job Postings
If you would like to be considered for any of the positions below, please click on the submit resume button to fill out the submission form.
For full job descriptions please email towne@townecareers.com
For full job descriptions please email towne@townecareers.com
Senior Clinical Informatics Analyst
Position Purpose: Interpret, manipulate, analyze, and report on large sets of client and prospective client claims and eligibility data, and explain the results of the analysis to internal and external clients.
Education/Experience: Bachelor’s degree in Science, Business Management, Accounting, Statistics, Healthcare or related field. Master's degree preferred. 5+ years of related experience.
- Interpret, manipulate, analyze, and report on large sets of client and prospective client claims and eligibility data.
- Create standard summary tables, reports & analyses, ad hoc analyses, and analytical data sets with critical business importance in SQL Server environment.
- Work with Director, Client Services to present analytic component of reports to the client.
- Present results of analysis to internal and external clients.
Education/Experience: Bachelor’s degree in Science, Business Management, Accounting, Statistics, Healthcare or related field. Master's degree preferred. 5+ years of related experience.
Director, Data Analysis - Des Moines, IA
Position Purpose: Lead analytical data needs for all HP’s and business units.
Bachelor’s degree in data related field. 9+ years of data analysis experience, preferably in risk adjustment analytics with a healthcare payor or 7+ years of related IT experience, including data warehouse, coding or ETL experience. Advanced SQL and Microsoft Access skills, relational database knowledge, and various data reporting tool experience preferred. Knowledge of statistics and application of high level mathematical models in medical and pharmacy claims data preferred. Understanding of health insurance business, claims payment procedures, strategies and trends in health care government programs preferred. Master’s degree and supervisory experience preferred. Encounters experience preferred.
- Initiate and lead company wide data processes improvements
- Lead cross functional activities related to large-scale analytic projects to deliver on schedule, within budget and with superior quality
- Develop and lead activities to accomplish overall strategic department goals and lead the communication of these goals to stakeholders at all levels of the organization
- Collaborate with health plan leadership to understand their data analysis needs, explain trends in data and actively drive further research and/or operational changes to assist in controlling medical costs and delivery of quality healthcare to members
- Participate in cross health plan initiatives and capabilities, including data analysis support
- Lead development efforts with technical team liaisons, including business requirements gathering and documentation, testing, delivery and user adoption, and effectively communicate deliverable expectations to the health plans and business units
- Lead system/tool implementation and design as needed
Bachelor’s degree in data related field. 9+ years of data analysis experience, preferably in risk adjustment analytics with a healthcare payor or 7+ years of related IT experience, including data warehouse, coding or ETL experience. Advanced SQL and Microsoft Access skills, relational database knowledge, and various data reporting tool experience preferred. Knowledge of statistics and application of high level mathematical models in medical and pharmacy claims data preferred. Understanding of health insurance business, claims payment procedures, strategies and trends in health care government programs preferred. Master’s degree and supervisory experience preferred. Encounters experience preferred.
Manager, Medical Management Outcomes
Position Purpose: Evaluate, design, develop and implement medical management initiatives to support the business needs through various clinical analysis
Education/Experience: Bachelor’s degree in Healthcare, Business, Quantitative science or related field. 4+ years business or clinical data analysis. Experience with medical coding practices, groupers and reimbursement practices. Comprehensive knowledge of current medical practices covering a broad range of medical specialties especially neonates and newborns. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Provider and claim systems (CCMS and Amisys) experience preferred. Knowledge of ICD-9, DRG’s and CPT codes preferred. Database management, SQL, Crystal Reports and/or COGNOS experience preferred.
- Develop and analyze various clinical data and reports on medical management programs, including authorization, utilization and case/disease management
- Develop databases, set benchmarks, identify root cause and recommend improvements
- Develop, create and implement database or automation to support and eliminate manual updates to programs within medical management
- Research, identify and monitor provider utilization trends and monitor providers for adherence to contract provisions.
- Report trends and refer cases for further investigation
- Conduct audits and ensuring consistency with all contractual requirements
- Respond to all inquiries related to provider assignments
- Establish criteria and strategy for pilot programs and advise on guidelines and system modifications that affect claims processing and payment decisions
Education/Experience: Bachelor’s degree in Healthcare, Business, Quantitative science or related field. 4+ years business or clinical data analysis. Experience with medical coding practices, groupers and reimbursement practices. Comprehensive knowledge of current medical practices covering a broad range of medical specialties especially neonates and newborns. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Provider and claim systems (CCMS and Amisys) experience preferred. Knowledge of ICD-9, DRG’s and CPT codes preferred. Database management, SQL, Crystal Reports and/or COGNOS experience preferred.
Senior Healthcare Analyst
Position Purpose:
The Senior Healthcare Analyst provides analytic support for financial modeling, trend analysis, therapeutic class strategy, and initiative implementation and measurement. Responsible for providing analytical support to Senior and Executive management for such processes as analyzing medical cost, and utilization trend drivers and their impact on overall financial performance.Develops custom reports and models used in identifying issues, trends, patterns and relationships to be applied in financial and operational decisions.
Responsibilities:
Education/Experience:
The Senior Healthcare Analyst provides analytic support for financial modeling, trend analysis, therapeutic class strategy, and initiative implementation and measurement. Responsible for providing analytical support to Senior and Executive management for such processes as analyzing medical cost, and utilization trend drivers and their impact on overall financial performance.Develops custom reports and models used in identifying issues, trends, patterns and relationships to be applied in financial and operational decisions.
Responsibilities:
- Communicates actionable findings, provides recommendations as appropriate to senior/executive management
- Acts as the primary analytical resource in the development and interpretation of key monthly cost
- Strengthen managements understanding of key drivers of medical cost and developing various "impact" and "scenario" models to assess financial exposure based on changes to business and contractual methodologies
- Serves as a lead resource for a team of Medical Cost Analysts
- Provides ad hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight
- Develop various sensitivity analytics to assess financial exposure based on changes to business/contractual methodologies
Education/Experience:
- Bachelor’s degree in Business, Finance or related field, required.
- Minimum of 5 years of Healthcare Analytical experience, required
- Strong proficiency in SQL, required
Manager Medical Economics
Must haves- Management/Supervisory experience, strong usage of SQL, healthcare background with some knowledge of claims/spending data. Will oversee a team of around 5 Analysts.
Summary
This position provides day to day guidance and tactical direction to a team of analysts. Develops data structures to facilitate the analysis of medical trends that exist within the business and recommends cost-saving initiatives in a meaningful way. Orchestrates and leads high level analytical reporting on all plans and products. Liaises with Information Technology in driving continued enhancement of company data warehouse. Supports Contracting and Provider departments in pricing negotiation and Utilization Management on value creation initiatives. Assists in providing support to other finance departments such as Accounting, Accounts Receivable and Actuarial.
Primary Responsibilities
· Collect, analyze, and summarize information and medical trends in order to prepare standard and ad hoc financial reports
· Hands on expertise in SQL programming and experience with enterprise wide data warehouses. Advanced skills in stored procedures, indexing and data normalization
· Recruit, select, orient, and train employees in order to maintain staff to meet objectives.
· Provide information, educational opportunities, and experiential growth opportunities in order to develop staff.
· Plan performance expectations, monitor, and appraise the associate's job results and performance in order to develop, counsel, or discipline staff members
· Communicate trend experience to mid-management level individuals
· Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes
Preferred Skills/Experience
· 5-8 years’ Analytics experience, required
· 3-5 years’ Management experience, required
· BA/BS - Bachelor’s Degree or equivalent, required
· MA/MS - Master’s Degree or equivalent, preferred
· IT Programming and Technical Training in Data Extraction & Modeling, preferred
· Managed Care/Health Care Experience Desired, required
· Experience working in a heavily regulated environment, desired
· Proficient in Microsoft Office, SQL, SAS, BI tools, required
Summary
This position provides day to day guidance and tactical direction to a team of analysts. Develops data structures to facilitate the analysis of medical trends that exist within the business and recommends cost-saving initiatives in a meaningful way. Orchestrates and leads high level analytical reporting on all plans and products. Liaises with Information Technology in driving continued enhancement of company data warehouse. Supports Contracting and Provider departments in pricing negotiation and Utilization Management on value creation initiatives. Assists in providing support to other finance departments such as Accounting, Accounts Receivable and Actuarial.
Primary Responsibilities
· Collect, analyze, and summarize information and medical trends in order to prepare standard and ad hoc financial reports
· Hands on expertise in SQL programming and experience with enterprise wide data warehouses. Advanced skills in stored procedures, indexing and data normalization
· Recruit, select, orient, and train employees in order to maintain staff to meet objectives.
· Provide information, educational opportunities, and experiential growth opportunities in order to develop staff.
· Plan performance expectations, monitor, and appraise the associate's job results and performance in order to develop, counsel, or discipline staff members
· Communicate trend experience to mid-management level individuals
· Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes
Preferred Skills/Experience
· 5-8 years’ Analytics experience, required
· 3-5 years’ Management experience, required
· BA/BS - Bachelor’s Degree or equivalent, required
· MA/MS - Master’s Degree or equivalent, preferred
· IT Programming and Technical Training in Data Extraction & Modeling, preferred
· Managed Care/Health Care Experience Desired, required
· Experience working in a heavily regulated environment, desired
· Proficient in Microsoft Office, SQL, SAS, BI tools, required
RN Intake Manager, Manage Long-term Care- NYC Based
Qualifications:
- Experience in development or acquisition, growth and operations of a Managed Long Term Care Program, Social HMO, Evercare, PACE, Medicare Advantage, and/or other programs for seniors with long term care needs.
- Previous experience working with regulators, medical, health and social service providers, and staff at all levels.
- Proven ability to affect outstanding healthcare and financial outcomes.
- Three to five years Management experience preferred.
- Knowledge of MLTC and/or home care assessment and reporting requirements such as OASIS,
- BA/BS - Bachelors Degree preferred.
- MA/MS - Masters Degree preferred.
- RN Licensed required.
Provider Relations Representative NYC
Responsibilities:
- Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.
- Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation's benefits and contracts through office visits and communication over the phone and email.
- Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
- Recruit non-participating providers to join our networks.
- Negotiate special deals to maintain compliance and increase access in weak networks.
- Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
- Facilitate Oral Health presentations to various educational institutions and organizations.
- Assist provider offices in filing their claims electronically.
- Serve as a liaison with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.
- Follow up with all termination letters submitted.
Senior Healthcare Economics Analyst
Responsibilities:
- Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments.
- Perform drill down analyses to identify the root causes for medical cost and utilization trend increases and decreases.
- Support Medical Management by assisting with Return on Investment (Rol) analyses for vendors to determine if their financial and clinical performance is achiving desired results.
- Bachelor's degree from an accredited institution.
- Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
Senior Healthcare Analyst-Hospital Reporting
Responsibilities:
- Produce and manage annual hospital performance review packets. The packets will include membership, revenue, and cost analysis for the hospital and overall “Company”. The person will be required to work with other departments to gather all relevant information on the hospital's performance.
- Monitor costs and revenue trends for hospitals and identify route cause of developing trends. Understand and analyze impacts of new program changes such as new benefits or new populations. Prepare monthly analysis for analytic council meetings.
- Respond to requests for analysis and provide analytic support to network management department and our owner hospitals. Required to pull data from warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) code and generate reports using SAS.
Healthcare Analyst
Responsibilities:
- Monitor and understand costs and revenue trends for Provider Organizations.
- Responsible for creating, modifying and updating financial reports and analysis for Provider Organizations.
- Document all coding, methodology and assumptions, data issues and report results for each analysis.
- Prepare periodic financial performance review presentations on the assigned Provider Organizations.
- Respond to ad-hoc requests from Network Management, Provider Organizations and physician groups. The requests include, but are not limited to, claims reports, Primary Care Physician Excess Medical Revenue (EMR) reports, and regulatory reports.
- Responsible for contract analysis and fee schedule modeling.
- Gather data and conduct ad-hoc analyses as directed by other Finance Analysis team members and assist with the development of reports.
- Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan and owner hospital performance.