Operations Manager, Health Economics & Info

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The manager will coordinate multiple projects, oversee day-to-day staffing, and administer all standard operating procedures.

Operational Data Store

• Under guidance of Director, oversee project management for all operational data store activities.
• Work closely with Analysts to create new functional specifications for enhancements or to improve existing logic based on changing business needs.
• Owner of change control process and documentation for each approved modification.
• Oversee test plan development, documentation and implementation process.
• Oversee creation of training documentation for new or updated designs for day-to-day data usage.

Operations Ad-Hoc Reporting

• Under guidance of Director and in collaboration with business owners, manage projects and prioritize all new reporting needs for daily on-demand and auto-delivered data.
• Oversee peer review process, ensuring quality and accuracy standards are met.

Operations Standardized Reporting

• Identify ad-hoc reporting that can be converted to standardized reporting for enhanced automation and increased efficiency.
• Recommend technological enhancements for improved standardized reporting.

Monitor Staff Productivity and System Performance

• Obtain functional requirements from business users on how they want to monitor staff productivity. Prepare confidential reports to fulfill this need.
• Time extracts and reports to oversee the length of time required for each. Merge with overall system performance metrics to provide recommendations to senior leadership.

We truly value our staff and further acknowledge their contributions by offering:

• Employee and family health coverage
• Competitive salaries
• Employer contributed pension plan
• Generous time off
• Tuition reimbursement
• 403(b) retirement plan

Bachelor's Degree in Statistics, Economics, Business or other related field required. Graduate Degree (MBA or CPA) in Statistics, Healthcare, Economics or Business preferred.

5 years experience in Healthcare Economics, Statistics, Data Analysis, Financial Reporting, Actuary, Managed Care, and/or Long Term Care operations experience required. Medicare and/or Medicaid Managed Care experience required. Experience with regulatory reporting required.

Knowledge of CMS & NYS DOH regulations preferred. Experience calculating IBNR, BCR (Benefic Cost Ratios) and other metrics preferred. Experience formulating MMCOR and encounter data preferred. Experience developing rate filings including Medicare Advantage Part C & D and MLTC preferred. Management experience preferred. Excellent organizational skills. Ability to work on multiple projects. Excellent Word, Excel, Access, Project, Visio skills. Excellent SQL Server 2008R2 (or better) skills with Reporting Services preferred.