Actuarial Informatics Manager

Thomas Jefferson University & Jefferson Health
United States, Pennsylvania, Philadelphia
Jan 20, 2025
Job Details Job Description The Manager, Actuarial Informatics is responsible for a specified team of informatics analysts. He/she coordinates projects and manages the team informatics functions including the monitoring of cost utilization trends, quality measure performance and network performance. This team is the key provider of data, information, and detailed analytics used to measure performance of population health initiatives at Jefferson and identifying improvement opportunities. Supports targeted initiatives for the Jefferson Clinically Integrated Network, the Delaware Valley ACO and the Jefferson Clinical Enterprise. Assists in maintaining a critical interdependence between the Actuarial Informatics team, other areas of the CMO department, IT, Finance, network contracting and other key Jefferson stakeholders. Strong knowledge of RDBMS platforms and ETL technologies and 3-5 years of business and systems development experience within the healthcare industry. Supervisory experience is desirable.ESSENTIAL FUNCTIONS: AnalyticsDevelops and maintains data/reporting systems that allow for ease of data retrieval and manipulation from a variety of sources including EHR, quality, claims payment, utilization management, health plan risk pools, pharmacy, lab, internal charges, and others as necessary.Responsibilities include the development and enhancement of Population Health "Key Performance Indicators and Metrics" used to measure and quantify Jeffersons Population Health (and ACO) experience through real-time reporting, early indicator reporting, and prospective and retrospective analyses. Develops financial models to assess performance of value based reimbursement arrangements.Develops models to evaluate provider network and Jefferson contract proposals.Identifies trends and recommends methods for reducing cost/utilization.Coordinates requests for analysis from internal and external clients including assignment, mentoring and establishing timelines.Performs research on industry performance measures.Develops departmental and individual goals.Ensures accuracy and readability of for all team projects.Performs additional duties as assigned.LeadershipResponsible for managing team, communicating and assigning tasks as appropriate, performing yearly performance evaluations, etc. Assist analysts in written analytic summaries used to communicate financial performance and trend analysis to Jefferson executives. Continuous ImprovementMaintains proficiency and expertise in Jefferson data applications, state of the art business intelligence software and reporting tools that include, but are not limited to, MS SQL Server Components (Query Analyzer coding, Analysis Server, Stored Procedures, Jobs, and Functions), Business Objects (Crystal Reports, Crystal Enterprise, Crystal Analysis, OLAP, and Xcelsius), SAS, and Microsoft Office (Word, Excel, PowerPoint, and Access) to prepare complex multi-factorial analysis. Continues development/enhancement of skill sets for direct reports. Actively pursues industry knowledge growth.Interacts with co-workers, visitors, and other staff consistent with the iSCORE values of Jefferson.EDUCATIONAL/TRAINING REQUIREMENTS:Bachelors Degree in Mathematics, Actuarial Science, Statistics or related field required. Masters degree preferred.Fellowship in Society of Actuaries and Member of the American Academy of Actuaries preferred.EXPERIENCE REQUIREMENTS:Minimum of 3-5 years of analysis experience related to health care or insurance with 1 year of supervisory experience preferred. In-depth knowledge of managed care and medical products. Work Shift Rotating (United States of America) Worker Sub Type Regular Primary Location Address 130 S 9th Street, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.