About this role
A remote healthcare data analyst role supporting utilization and care management programs through data analysis, reporting, and insights to improve member outcomes and operational efficiency.
Key Responsibilities
- Analyze UM and CM data
- Develop dashboards and reports
- Perform claims and authorization data analysis
- Support population health efforts
- Present data insights to stakeholders
Technical Overview
Involves healthcare data analysis using SQL and Python, dashboard/report development with Tableau or Power BI, and expertise in healthcare claims, HEDIS, and CMS metrics.
Ideal Candidate
The ideal candidate is a healthcare data analyst with 3+ years of experience in utilization and care management data analysis, proficient in SQL and Python, with strong skills in dashboard creation and healthcare metrics.
Must-Have Skills
Bachelor’s degree in Data AnalyticsHealth InformaticsStatisticsor related field3-5+ years of data analytics experience in health plan or managed careExperience analyzing Utilization Management and/or Care Management dataProficiency with Python or SQLExperience with data visualization tools like Tableau or Power BIUnderstanding healthcare claimsauthorizationsand eligibility data
Nice-to-Have Skills
Experience with population health analyticsKnowledge of HEDISCMS quality metricsExperience with large healthcare datasetsFamiliarity with risk adjustment models (HCCRAFCDPSCRGACG)
Tools & Platforms
PythonSQLTableauPower BI
Required Skills
Healthcare data analysisUtilization ManagementCare ManagementClaims analysisData validationDashboard developmentReport automationPopulation healthRisk stratificationData visualizationSQLPythonHEDISCMS quality metricsValue-based care
Hard Skills
Healthcare data analysisUtilization ManagementCare ManagementClaims analysisData validationDashboard developmentReport automationPopulation healthRisk stratificationData visualizationSQLPythonHEDISCMS quality metricsValue-based care
Soft Skills
Analytical skillsProblem-solvingCommunicationCollaborationAttention to detail
Certifications
Preferred
HEDISCMS quality metricsRisk adjustment models
Keywords for Your Resume
Healthcare data analysisUtilization ManagementCare ManagementClaims analysisData validationDashboard developmentReport automationPopulation healthRisk stratificationData visualizationSQLPythonHEDISCMS quality metricsValue-based care
Deal Breakers
Less than 3 years of healthcare data analysis experience, No experience with SQL or Python, Lack of familiarity with healthcare claims and metrics, Inability to work remotely
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