Blue Cross Blue Shield of Michigan Health Services Researcher (Data Scientist) in Detroit, Michigan

Description

DEPARTMENT SUMMARY:

Independently leads health research projects by performing conceptualization, design, execution, and interpretation of novel BCBSM fee-for-value and risk-based initiatives. Partners with Health Care Value, Health Plan Business, and Emerging Markets staff to provide well-defined, accurate, and timely analyses that answer client questions; drives the completion of these analyses through project management of other HCVA&I; staff..., Monitors existing programs, and leverages evidence based analyses to guide decision making across various health insurance products. Provides leadership that yield quantitative collaborations to enhance health care value.

ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following. Other duties may be assigned.

  1. Independently performs risk adjustment, case definition, generation of data visualization dashboards, and ad hoc analyses. Supports clinical metrics development, methods development, incentive recommendations under the counsel of a senior Program Development & Analytics staff member. Executes implementation of research questions on defined data sources.

  2. Serves as lead for defined projects, and executes project management with other HCVA&I; staff. Responsible for providing high quality, accurate, and timely project deliverables.

  3. Supports strategic discussions with PDA Leadership and leadership across HCV and BCBSM by providing model results derived from BCBSM data marts and registries.

  4. Designs and implements straightforward research projects to understand the disease burden in BCBSM insured population and health care services being utilized for disease diagnosis and treatment. Assists in working cross-functionally to obtain clinical and operational input.

  5. Interprets and presents results to a variety of quantitative and non-quantitative audiences.

  6. Defines programming specifications for analyses and validates the programming of other HCVA&I; staff. Performs primary programming for exploratory data analysis.

Involved in advanced analytics in support of conceptualization, design and evaluation of BCBSM clinical programs, such as the largest Patient-Centered-Medical Home initiative in the nation and numerous pay-for-performance initiatives.

Design and implement epidemiologic studies to understand disease burden in BCBSM insured population and health care services being utilized for disease diagnosis and treatment. Identify opportunities for clinical programs. Assist in the planning and implementation of clinical programs to prevent and control diseases and to improve quality and efficiency of care delivered to BCBSM insured population. Design and implement epidemiologic studies to evaluate the effectiveness of clinical programs. Prepare presentations and technical reports in a clear and concise manner to communicate finding from epidemiologic studies to management, providers and other interested parties. Disseminate research results through presentations to scientific and professional groups and through publications in scientific and professional journals. Provides consultation to Michigan providers, physician organization and other interested groups. Other duties may be assigned.

Qualifications
  • Master's Degree in Public Health, Epidemiology, Health Administration or other related field
  • At least two (2) years experience in Epidemiology or related field
  • Knowledge of complex epidemiologic and surveillance methods
  • Knowledge of current concepts of population health manage, program evaluation and needs assessment
  • Knowledge of health insurance and health care industry in general, more specific about BCBSM business, products and programs.
  • Must possess a working knowledge and understanding of how physicians and other providers practice can vary.
  • Ability to write reports for internal and external customers.
  • Ability to function independently, manage multiple tasks and work effectively under minimal supervision.
  • Working knowledge of PC and mainframe applications and computer systems.
  • Ability to present and defend work findings and decisions under the stress of conflict and challenges while maintaining a professional image.
  • Strong analytical, organizational, verbal and written communication skills.
  • Strong working knowledge of data languages such as SAS or SQL.

Department preferred EDUCATION AND/OR EXPERIENCE:

  1. Master's Degree in Public Health, Epidemiology, Health Services Research, Health Administration, Nursing/Clinical discipline, Health Policy, or other related field; quantitative training is required.

  2. At least two (2) years of experience in applied health services research.

  3. At least two (2) years of experience in a payer or related environment. Experience with health insurance products, such as PPO, HMO, or commercial Medicare. Experience in fee-for-value programs. Exposure to payer issues such as network management, cost of care, hospital readmissions, and in-patient admissions.

  4. Quantitative experience in population health management, quasi-experimental design, survey design and analysis, observational data methods, sampling techniques, metric development, risk adjustment, attribution methodologies, and needs assessment. Experience in a clinical area a plus.

  5. Experience in CMS guidelines, ICD-10, HCPCS and CPT codes. Experience in HL7 a plus.

  6. Knowledgeable in SAS and SQL programming languages. Familiarity in mining databases Programming experience in R, SPSS, Python or other statistical analysis packages a plus.

  7. Excellent oral, listening, and written communication skills that includes presentation of analytic results to a public speaking audience. Prior consulting experience a plus.

  8. Familiarity with analyzing electronic medical records, unstructured data, and/or registry data a plus.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.

Job: Health Care Management

Primary Location: Detroit

Organization: HCV Performance & Execution-2140

Schedule: Full-time

Req ID: PRO000DH