SUMMARY OF POSITION :
• Provide oversight and leadership for the creation and utilization of key performance indicators for clinical/business owners
and senior executive management that continuously identifies opportunities for revenue and medical expense optimization for
the organization. This includes focused review of various segmentations of healthcare data such as product and service
revenue, member health risk, provider utilization, cost and quality by market segment, line of business, value based contract
arrangements and other business areas.
• Ensure that EmblemHealth’s business intelligence tools are market leading, being deployed and support analysis and
reporting of population health, provider profiling activities, and line of business product reporting. Drive the development and
use of analytical processes for the identification (retrospective and prospective) and measurement and evaluation of revenue
and medical expense optimization initiatives.
• Keep abreast of competitor and network capabilities and remain alert to trends and future policies as they relate to changes
which might impact the business. Maintain up to date industry knowledge of new information and technologies and their
application to EmblemHealth. Recommend adaptations and changes that result in savings and efficiencies based on data
models; develop and implement action plans based upon data and information relative to revenue generation and health care
cost trends.
• Drive thought leadership on evolving EmblemHealth’s analytics capabilities in support of consumer oriented products,
wellness programs and loyalty programs and other industry transformations; ensure that the organization’s information needs
are met in a manner that reflects industry best practices in terms of efficiency, cost effectiveness, accuracy, and accessibility.
• Facilitate the identification of external benchmark vendors to compare EmblemHealth actual results to industry standards
looking at external revenue generation and medical utilization, unit cost and trend information to help develop target
performance levels
• Support other areas in implementing cross departmental changes. Assures conformance with legal and regulatory
requirements.
LEADERSHIP EXPECTATIONS :
•Strategic ThinkinG - Anticipates and identifies changes in the marketplace. Develops organizational vision and sets strategic
direction. Develops and champions change efforts in redefining how to serve customers.
•Organizational Development - Develops cost effective organization structure with clear roles & accountabilities. Identifies,
selects, develops, and engages talent. Identifies successors and prepares them for additional responsibilities. Holds VPs
accountable for developing others. Assesses and rewards leader performance across the organization. Recognizes and
celebrates success.
•Transparent Communication - Constantly communicates business strategy to leaders and employees. Role models frequent
cascade of information. Build trusts with others by being transparent with communications, dashboard/metrics. Is dynamic
and engaging when sharing information.
•Lives the Values - Makes decisions that support the values. Demonstrates the values in daily activities. Holds VPs accountable
for living the values. Places Company and team above self.
•Continuous Improvement - Sets stretch goals that improve performance. Anticipates and manages organizational risks. Seeks
out areas that require innovation. Drives for operational excellence by finding process improvements. Leads efforts to create a
work environment that is open to new ideas and thinking. Models continuous improvement in self.
•Accountability - Holds self and VPs accountable for achieving results. Identifies obstacles to getting things done in the
organization. Makes decisions in timely manner. Willing and able to drive change.
DELIVERABLES :
• Make significant contributions towards EmblemHealth’s short- and long- term business initiatives which include Operating
Income, Administrative Expenses, Medicare & Medicaid ratings, and Net Promoter Score performance. [specific metrics and
benchmarks to be provided]
• Identify, hire, & train staff members, developing them into strong leaders and creating high-performing, self-directed teams.
Effectively plan for succession planning ensuring talent pipeline.
• Act as change agent to drive and effect organizational change ensuring key deliverables are met. [specifics to be provided]
EDUCATION AND RELEVANT EXPERIENCE :
• Bachelor’s degree in Computer Science or in a business, analytical, or related field; Master’s preferred.
• 12 – 15 years of managed care experience.
• 7 - 10 years of data analytics experience, including 5 + years in a leadership role.
• Must have experience with formulating hypotheses and proving/disproving through research.
• Strong understanding of risk/value based provider arrangements and value based benefits.
• Strong understanding of the PPO/HMO healthcare data model; and of healthcare financial, statistical and analytical reporting,
including Hyperion, PeopleSoft, SAS and Medstat, and with advanced BI tools
• Experience implementing advanced statistics (including regression, classification, clustering, hypothesis testing), advanced
analytics, and predictive modeling techniques in the healthcare industry; and using Python, R, SQL, Tableau and big data tools
including Hadoop and Spark.
• Possess exceptional executive level management and communication (verbal, written, presentation) skills.
• Knowledge and understanding of managed care principles, industry evolution and physician reimbursement.