Senior Project Management Analyst

📁
Manager & Professional
💼
ConnectiCare
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Support strategic initiatives to innovate for improved patient care and service to the membership across the EmblemHealth enterprise by serving as liaison between business and IT to ensure achievement of desired outcomes.Develop and deploy improvements to procedures and processes; support the ongoing operational needs of key programs administered through vendors and the enterprise aimed at improving quality of health care (including efficiency, service, and clinical outcomes), clinical integration, and system improvement. Support the implementation of all new clinical, medical management and medical cost  programs which may include creation of business and functional requirement documents, test strategy and plans, establishing FTP connectivity. Monitor progress of projects, enhancements and defect remediation (PPM, CR, SR, Incidents), providing feedback and recommendations to drive successful results; compile and present results of analyses to appropriate parties; develop and prepare meeting materials that provide information as to progress metrics. Ensure vendor file exchange supports business requirements: frequency of files, data integrity, delivery, etc. 

Responsibilities

  • Monitor scheduled clinical and medical management data files delivery process including but not limited to eligibility, provider, authorization, paid claim files in conjunction with business functional areas and IT. 
  • Manage and resolve provider and/or member participation issues in clinical, medical management and medical cost reduction programs related to data transfer issues (e.g. enrollment/benefits).
  • Facilitate the correction of any issues identified and submission to vendors. 
  • Identify changes in SLAs, systems, contracts, parameters, or requirements; assist with the implementation of any modification to files as dictated by future requirements and/or changes.
  • Triage issues to functional areas / key stakeholders as needed to resolve in timely manner.
  • Cultivate strong relationships internally with key stakeholders for effective cross-functional collaboration.
  • Identify, anticipate, prevent, and mitigate/resolve issues and obstacles that impede project completion.
  • Serve as business liaison to functional areas for vendor related issues including but not limited to benefit plan set up, eligibility file setup, provider file and claim/ encounter file errors.
  • Collaborate with the Network Project Manager on implementation of new programs to support management of target populations, performance metrics and vendor arrangements.
  • In conjunction with Network Project Manager, manage the coordination of various workgroups, committee meetings, and other best practice sharing events.
  • Perform other related projects and duties as assigned.


 

Qualifications

  • Bachelor’s degree in Business, Finance, Health Administration or related field required.
  • 5 - 8 years’ experience in operations or program management within the healthcare industry required.
  • Experience and strong interest in operations management in healthcare or community-based services required.
  • Ability to prioritize and resolve critical issues efficiently and effectively required.
  • Strong quantitative, analytical and technical skills relating to data management, analysis and presentation required.
  • Experience analyzing and manipulating data sets and creating effective presentations required.
  • Strong PC / Microsoft application skills including Word, Advanced Excel, and PowerPoint required.
  • Strong communication skills (verbal, written, presentation, interpersonal) required.
  • Ability to effectively plan and facilitate meetings and workgroups required.
  • Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage to schedule required.
  • High degree of initiative along with ability to act as a team player required.
  • Ability to develop effective relationships with a broad array of people (different levels of management & clinical experts) required.

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