Managed Care Strategy * Maintains a keen awareness of the external business environment and prospects for garnering/improving new payer agreements and/or favorable payment provisions. * Through the use of all data sources, including market and publicly available data, develops a thorough understanding of the Connecticut healthcare market and the main Insurance Company participants. * Understands Yale Medicine's strategic position and each specialty service's needs by both developing working relationships across the Practice and Departments and performing in-depth analysis of rates, utilization, and quality of care using internal data and third-party claims data. * Assists in the development of overall Yale Medicine managed care strategy and in the implementation of that strategy. * Provides Leadership with detailed market/company insight and analysis, based on a thorough understanding of the Connecticut healthcare market. * Performs regular analyses on contract rate validation, utilization, and payer performance. * Assists in developing financial models to support contract renewals or new agreement designs. Managed Care Payer Relations * Ensures that provider services agreements can be supported and key deliverables or performance targets upheld in advance of committing the organization to terms. * Supports the delivery of critical information concerning covered services, par providers, carve-outs and fee schedules to affected internal clients in a timely manner; facilitates clear and unequivocal communications between contractors and health system clientele as necessary to ensure smooth implementation of agreements. * Supports Contract Officer on Payer Policy review to assess financial impact of upcoming policies on revenue. Work with internal departments to better understand systemic impact and further communicate back with Payer for additional information and development of objection communications * Create contract inventory on key provisions in the Agreements for accessibility of information and assist in strategizing for improved language and consistency amongst the payers * Work with various departments on their specific contracting needs and work with Contract Officer and Payers to support and maximize our revenue * Support Contract Officer with analytic needs as part of overall negotiation with Payers, ad-hoc requests and other support for strategic purposes
Required Skill/ability 5: Political savvy, strong ethics and teamwork skills. Strong analytical and problem-solving skills, able to break down a problem to actionable items and drive results.
Posting Position Title: Managed Care Analyst
Required Skill/ability 3: Comfortable working in an environment with high ambiguity.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Managed Care Analyst, YMA
Required Skill/ability 1: Exceptional communication skills, both verbal and written.
Required Skill/ability 4: Operational understanding of planning and marketing, finance, business office systems, human resources, hospital operations and medical staff leadership.
Required Skill/ability 2: Excellent negotiation and partnering skills. Ability to make tough decisions with confidence.
Bachelor's Degree and 5 years experience in data analytics, statistics, and/or business operations in a healthcare environment or equivalent combination of education and experience - Understanding of and prior experience with managed care/payment approaches
Yale University is an American private Ivy League research university located in New Haven, Connecticut. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States.