Job Summary
We are seeking a highly skilled and dedicated Senior Analyst for our Health Home program. The ideal candidate will possess extensive experience in healthcare analysis, case management, and behavioral health, with a strong understanding of hospital operations, patient care coordination, and managed care principles. As a Senior Analyst, you will lead efforts in data collection, utilization review, and care planning to optimize patient outcomes and ensure compliance with healthcare standards. Your leadership will be instrumental in advancing our health home initiatives by integrating clinical expertise with analytical proficiency.
Responsibilities
- Conduct comprehensive patient assessments to inform individualized care plans, integrating medical, behavioral health, and social determinants of health.
- Lead utilization review processes to evaluate appropriateness of services and ensure adherence to Medicare, NCQA standards, and HIPAA regulations.
- Oversee the review of medical records and documentation to maintain accuracy, completeness, and compliance with regulatory requirements.
- Collaborate with multidisciplinary teams—including social workers, nurses, physicians, and behavioral health specialists—to coordinate discharge planning and post-acute care services.
- Develop and monitor care management strategies that address complex patient needs within hospital settings such as Level I Trauma Centers, Level II Trauma Centers, PICUs (Pediatric Intensive Care Units), and emergency departments.
- Manage data collection efforts related to patient care metrics, quality improvement initiatives, and behavioral health interventions to support program evaluation and reporting.
- Provide leadership in supervising case management staff, fostering professional development while ensuring high standards of patient care delivery.
- Ensure compliance with all relevant healthcare regulations including HIPAA privacy rules while maintaining meticulous medical records documentation.
Requirements
- Proven experience working within hospital environments such as trauma centers, ICU units, emergency medicine departments, or pediatric intensive care units.
- Strong background in nursing or healthcare analysis with familiarity in acute care settings including hospice care and home health services.
- Knowledge of behavioral health practices including mental health counseling and addiction counseling techniques.
- Experience in managing complex cases involving social work, discharge planning, and behavioral therapy interventions.
- Familiarity with managed care principles, Medicare policies, NCQA standards, and utilization review processes.
- Excellent understanding of medical terminology, anatomy, physiology, and patient assessment methodologies.
- Demonstrated leadership skills with supervising experience in healthcare teams or case management programs.
- Ability to analyze data effectively for quality improvement initiatives while ensuring compliance with HIPAA regulations.
- Strong organizational skills combined with the ability to communicate clearly across multidisciplinary teams in fast-paced hospital environments. Join us in delivering exceptional patient-centered care through innovative analysis and collaborative leadership within our dynamic healthcare setting!
Pay: $110,000.00 - $114,000.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
Work Location: In person
