Director, Business Intelligence

Welcome to Montage Health’s application process!

Job Description:

HYBRID POSITION - 50% ON-SITE/50% REMOTE

The Director of Business Intelligence is responsible for the direction and oversight of the Business Intelligence (BI) functions, including research, reporting, and consultation for the purposes of advancing the quality, service and affordability goals of Aspire Health Plan and to support Aspire leadership in making high-quality, data-driven decisions. Director, in collaboration with the HIT Division, will facilitate organizational data strategies for governance, design, development, implementation, integration and usage of business intelligence tools and applications across the Aspire organization. The Director should be a business intelligence professional with experience in using data analytics and data management tools to support and improve quality outcomes, utilization management, cost management, and business growth objectives.  This individual will need to understand the strategic objectives of Aspire Health, direct and oversee business intelligence strategic and tactical development decisions, and assist in the design and production of key performance indicators for use at all levels of the organization. The Director will assist with strategic decision making and provide senior leadership throughout the organization with information and tools for business decision making and planning.  In addition to developing and maintaining strong relationship within Aspire Health the Director is also responsible for maintaining relationships and supporting cross-functional projects across Aspire parent organizations, Montage Health and Salinas Valley Health.

AREAS OF RESPONSIBILITY

• Developing and managing business intelligence solutions for the organization.
• Partner with HIT to build a robust Healthcare Information Technology solution with major focus on data warehouse and its structure. Take a lead role in development of analytic tools, extract data from data warehouses, and ensure data integrity through validation efforts.
• Working closely with the Montage HIT team and Aspire’s executive team, ensures that IT functions are transitioned to the HIT team and consistently performed, meeting regulatory, compliance and business standards
• Provide consultation to senior leadership on the interpretation of analysis output, making recommendations regarding the design and deployment of clinical intervention initiatives and the measurement of their success.
• Analyzing business requirements, processes and recommending them to the management and executives for implementation.
• Regular contact with Director(s) to maintain providers input and constant communication regarding proposed performance improvement strategies.
• Management of team for the purpose of ingesting data in Trello and other channels and executing the company’s mission.
• Provide operational, clinical and strategic level intelligence by mining complex data within the Epic system.
• Perform Market Assessments and conduct periodic customer specific and industry specific reporting. Work with Tableau & Epic Analysts to develop accurate and reliable reports and dashboards for real time performance monitoring by leading efforts to establish timely and reliable dashboards and tracking mechanisms.
• Acquire and maintain expert knowledge of CMS Merit-based Incentive Payment System (MIPS), Aspire Health Medicare Advantage, Aspire Health Self Insured Employee Plan, CCAH Medi-Cal CBI & Advanced Payment Model, Commercial Pay for Performance plans, NCQA’s Patient-Centered Medical Home (PCMH) and Patient-Centered Specialty Practice (PCSP) standards, as well as other new innovative payment models such as CMS Medicare Shared Savings Program (MSSP) and CMS Primary Care First (PCF).
• Search and evaluate potential opportunities and make pursuit recommendations to then Aspire leadership team.
• Conduct Data Governance. Serve as a liaison between Director(s) and HIT for report questions, validation and other HIT related issues.
• Monitor program compliance and work with Aspire’s leadership team to develop new policies and procedures necessary for quality improvement and quality incentive programs such as Medicare STARs and commercial plan partners ACO products while evaluating existing policies for compliance with the programs’ models.
• Work closely with Strategic and Operational Leaders to maximize the results for quality initiatives and shared savings programs and other quality-based payment programs.
• Create strategies to tease apart the relative impact and ROI of multiple concurrent initiatives.
• Oversee staff work estimates, analysis design, assigns and coordinates projects within the Business Analytics team and across analytics teams of Aspire’s parent organizations and medical groups. 
• Provide staff with business context to inform their analyses
• Oversee the development of models to analyze and present claims, EHR and other data using various sources to identify health factors that are expected to drive future costs and utilization of medical benefit and overall healthcare services.
• Maintain a working knowledge of billing and coding. Maintain awareness of current events and their effect on the healthcare industry (at the federal, state, and local levels).
• In conjunction with the medical group partners, support the development and maintenance of tools to support Epic users and providers. Suggest improvements to the system, adaptation to system changes and assist departmental co-workers to learn new system changes.
• Specify the optimal design and statistical approach needed to meet goals of pilot studies, new technology assessments and partnerships, along with estimates of the skill, time, and effort needed to execute them.
• Manage all aspects of assigned studies including but not limited to data acquisition & preparation, analysis, interpretation, and reporting.
• Identify and executes opportunities for streamlining process so that similar analyses can be more efficiently implemented in the future (including automating them where feasible).
• Help drive increased corporate awareness / understanding of selected analytic strategies, e.g. via targeted training opportunities, mentoring junior staff, internal peer-review meetings, publications, mini-courses, and other relevant documentation.
• Stay abreast of national trends in healthcare analytics and services research; and attends/presents at relevant national conferences as needed.
• Actively participate in managers meetings, provider meetings, educational seminars and in-services, as needed. Attend workshops, conferences, and/or seminars to keep current and expand knowledge regarding payment systems, operations, strategy as well as, interpersonal and communication skills.

• Work independently on routine assignments and strive to improve skills & problem-solving abilities.
• At the request of Aspire leadership, serve as a liaison to Aspire’s parent organizations (Montage Health and Salinas Valley Health entities) and external organizations representing Aspire’s interests relative to strategic activities.

SUPERVISORY RESPONSIBILITIES:

Project planning, time management, ensuring projects meet deadlines with expected deliverables. This position carries supervisory responsibilities of Aspire’s Business Intelligence staff and shared staff between BI and HIT.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Five or more years of BI experience in healthcare
• Knowledge and expertise with pulling and managing health plan, Medicare, or large multispecialty medical group financial and clinical datasets
• Knowledge and expertise in Epic, SQL, Tableau, advanced Excel
• Knowledge and skills in statistical analysis
• Proficient organizational, written, verbal and presentation skills
• Experience collaborating between information technology and practice operations
• Analytical understanding of health plan operations and clinical workflow processes
• Proficient organizational, written, verbal and presentation skills

EDUCATION and/or EXPERIENCE:

• Bachelor’s degree
• An advanced degree, such as an MBA, Masters in Public Health, Masters in Healthcare Informatics, preferred. 
• Experience: 5 years or more of business intelligence, data analyst management experience in a healthcare related field, preferably in health plan, large multispecialty medical group practice management and/or population management
• Functional knowledge of:
  • MIPS, HEDIS, PCMH/PCSP
  • Ambulatory practice operations
  • Developing and implementing operational change
  • Project management techniques
  • Physician practice finances, budgeting, coding, and claims processing
• Experience in designing and maintaining performance measurement systems (i.e. metric design, procurement and validation, metric display, charter development, change concept identification and deployment, rapid cycle change and diffusion, and on-going monitoring).
• Strong interpersonal skills and able to communicate and interface across all levels of the organization
• Work as a member of a team as well as be a self-motivator with ability to work independently
• Highly proficient Word, Excel and PowerPoint

ABOUT ASPIRE HEALTH:

Aspire Health, owned jointly by Montage Health (MH) and Salinas Valley Health (SVH), provides better health outcomes by bringing together people, providers, payers and community partners to promote wellness and deliver the best possible care, service and value. The primary purpose of Aspire is to improve the health of the populations it serves by using the tools of population health (care management, disease management and addressing social determinants of health) and creating the right incentives to do so.

Included in Aspire Health is Aspire Health Plan ("Plan"), which is licensed by the California Department of Managed Health Care ("DMHC") as a Knox-Keene Health Care Service Plan, and has entered into a contract with the Centers for Medicare and Medicaid Service ("CMS") to be designated as a Medicare Advantage Plan. Over 700 physicians, all four Monterey County hospitals and other local healthcare providers are part of the Aspire Health Plan network across Monterey County. The Plan has a multidisciplinary team that manages healthcare benefit services for high-quality and cost-effective care delivery on behalf of the health plan sponsors it serves, whether that is the government (Medicare) in Monterey County or for commercial employers in the central coast region.

Aspire Health conducts business in four market segments: 1) Medicare Advantage Plans, 2) Third-party administrator for two self-funded health plans for Montage Health and Salinas Valley Memorial Healthcare System employees, 3) Commercial HMO business involving professional risk and service delegation for Anthem HMO, and Blue Shield Trio HMO, and 4) Two accountable care organization (ACO) contracts for a total of > 40,000 lives with Anthem Blue Cross and Blue Shield.

In addition to the health plan, Aspire Health offers population health programs and services designed to promote wellness, improve care and help lower healthcare costs for everyone in Monterey County. It helps people find solutions to overcome barriers to good health - financial, emotional, behavioral and clinical - so they can be more active, independent and in control of their health. This program also helps communities in Monterey County address major health issues, such as diabetes, through coaching, care management and education.

Salary Range: $172,000-$179,000

Equal opportunity employer.

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