DaVita Medical Services Analyst, Senior in EL SEGUNDO, California

Medical Services Analyst, Senior

Description

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.

If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

Overview:

Responsiblefor providing analyses and developing systems to ensure appropriate, cost-effectiveand efficacious delivery and authorization of medical services. Identifiesutilization variances and provides actionable information to decision-makers toalleviate variances with a special emphasis on providing inpatient utilization(bed days) data and analysis.

Essential Functions:

  • Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners’ (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.

  • Conducts analyses for medical utilization,including but not limited to: primary care, specialty referrals, ancillaryservices, outpatient surgeries, hospital and SNF’s.

  • Interacts with ad-hoc customers and managementteams to review historical practices and proactively identifies enhancementopportunities.

  • Acquires and mines data to identify utilizationvariance across multiple defined or suspected dimensions including regional,demographic, financial and medical specialty.

  • Identifies areas where reducing variation inmedical practice would result in improved quality of care and / or reducedcosts.

  • Analyzes alternative service delivery (PCP vs.specialist, employed vs. contracted, FFS vs. capitated).

  • Produces tools or reports that place actionableinformation in the hands of management and their supporting staff.

  • Creates user-friendly solutions that allowindependent clients to get the specific information they need.

  • Develops and maintains internal software(databases, procedures, report interfaces, interactive spreadsheets etc.) toacquire, process, summarize and share information.

  • Provides detailed data to operational units forresearching exposed variances and develops, where appropriate, “drill-through”capabilities on new and existing reports.

  • Tracks outcomes of internal programs based onoverall utilization, costs or measures defined by program and provides inputand outcome data for various disease or treatment-related programs (oncology,DM programs, etc.).

  • Works with external clients and internal liaisonsto provide HCP data for grant programs, patient management contracts, andacademic studies.

  • Exhibits and applies specialized knowledge of allinpatient utilization metrics and the specialty referral process.

  • Exhibits and applies understanding of the medicaland operational systems at HCP which drive healthcare utilization.

  • Identifies and works with regions to definepractical or erroneous variations in utilization (due to contracting,population, etc) which skew reported outcomes and supports Decision Supportmanagement in helping operational units eliminate faulty practices.

  • Implements systemic reporting changes to compensatefor known and appropriate variances.

  • Executes the Provider Profile.

  • Prepares scheduled and adhoc pay for performance(P4P) reports not covered bythe Patient Information Portal (PiP).

  • Provides input data for other department analysesor programs.

  • Processes any input indexes of patients, codes,etc.

  • Establishes and updates systems and best practicesfor acquiring utilization data from a variety of sources.

  • Reuses and makes available to Decision SupportServices any “universal coding practices”.

  • Develops simple software to allow operational unitsto acquire or record essential function related data.

  • Supports provider incentive programs.

  • Uses, protects, and discloses HCP patients’protected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.

  • Master’s degree preferred.

EXPERIENCE:

Minimum:

  • Over 3 years and up to and including 5 years of experience in analytical research and / or program evaluation experience (2 years of which can be substituted with equivalent graduate-degree work).

  • Healthcare experience required.

Preferred:

  • 2 or more years experience in Managed Care or at a Medical Group.

KNOWLEDGE, SKILLS, ABILITIES:

  • Proficient in Microsoft Office applications.

  • Ability to develop data driven solutions in Microsoft Access or similar (preferably SQL Server with Reporting Services).

  • Excellent analytical and problem solving skills.

  • Excellent verbal and written communication skills.

  • Specialized knowledge of inpatient utilization metrics and the specialty referral process.

  • Understanding of medical and operational and the driving forces of healthcare utilization.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.

Primary Location CA-EL SEGUNDO - 90245

Req ID: 309676