Responsible for providing clinical consulting support for HUB International’s comprehensive healthcare data analytics system (Infused Analytics [IA]), including deep dive catastrophic claims reviews, clinical note interpretation, and summarization of complex clinical data and prognoses. Working with Clinical Informatics team and its developers, create recommendations for additional or modifications to the IA platform. Guidance and leadership in the design and development of strategies for HUB International’s product offerings where clinical oversight is necessary.

Provides oversight and management of new client integrations into IA, including contract reviews with HUB International’s legal team and insurance carriers, validation of levels of aggregation and client control totals. Works with local HUB employees to ensure client set up is accurate prior to production. Conducts necessary training for HUB employees and clients as it pertains to the useability and interactivity of the IA platform. Also serves as a resource liaison between vendors, such as stop loss carriers, point solutions, clients and HUB International producers, consultants, and account executives pertaining to clinical services associated with a client’s benefits program.

KEY JOB FUNCTIONS AND RESPONSIBILITIES

• Using HUB International’s Infused Analytics (IA) platform and other analytics tools, manages, evaluates, decodes claims data across service lines/initiatives (eligibility, medical, pharmacy, dental, well-being, onsite clinics, point solutions, etc.)

• Through a clinical lens identifies key opportunities to cost mitigate, transfer or contain risk and/or reduce waste that improves population and plan performance.

• Supports the efforts in cross-functional workgroups, including but not limited to: Employee Benefits, Health & Performance, Clinical Consulting, Analytics, Informatics, Pharmacy and Sales.

• Establishes turn-key processes and corresponding training related to core clinical consulting and data analytics services.

• Supports HUB consultants, producers, and services teams by offering consultative support for claims utilization, quality metrics, and creating strategies to improve clinical KPIs.

• Manages the HUB International claims benchmarking process, including the design and development of reports, insights and white papers as it pertains to trends by industry, region, etc.

• Delivers client-specific trend reports compared to HUB’s book of business benchmark and other proprietary benchmarks within IA – this includes clinical prevalence modeling, per 1,000 metrics, cost and trend comparisons and health plan/program nuances impacting performance.

• Prepares and delivers monthly / quarterly reporting packages using HUB’s data lake provider and create trigger notifications within IA for HUB employees and clients to identify worsening or improved trends within a client’s health plan.

• Acts as a clinical subject matter expert and collaborates with other HUB clinicians such as HUB’s MDs, DNPs, PharmDs and RNs.

• Supports HUB’s stop loss partners with collaborative services related to pre-identification catastrophic risk, 50% reports, impending risk, and stop loss claimants.

• Collaborates with stop loss partner’s clinical teams and meets regularly to review high-cost claim activity and develops (in partnership) the strategies to address catastrophic risk.

• Develops trigger diagnoses reports and vigilant reports for the pharmacy practice to allow the HUB employee benefits team to pre-emptively evaluate solutions to reduce client risk.

• Assists Health and Performance practice in validating/reviewing best practices pertaining to evidence-based solutions, including the recommendation of health intervention programs that lead to improved plan and population health.

• Supports national pharmacy practice with the EmpoweRx™ claims repricing program, including bid file set ups, interpretation of pharmacy data, and recommendations related to formulary design, etc.

• Aids HUB’s Value-Based Healthcare practice, including claims review, review of quality metrics and adherence to evidence-based protocols.

• Maintains strict and rigorous compliance related to data, PHI, PII, and other relevant local, state and national regulations governed under HIPAA and related laws.

• Other duties as assigned.

QUALIFICATIONS

EDUCATION / EXPERIENCE

• Bachelor’s degree in a health-related field required, candidates with clinical degrees such as nursing, epidemiology, or pre-medicine are encouraged to apply.

• Associate-Level Licensed Practical/Registered Nurses with ten (10) years or more experience, in lieu of a bachelor’s degree acceptable; PhD in a health-related field, MD, DNP or PharmD a plus

• Five (5) to ten (10) years of direct health informatics experience desired.

• Experience with Johns’ Hopkins University’s ACG system, magic quadrant technology providers and/or employer-focused data warehouse preferred.

• Experience with insurance, employee benefits, and/or health & wellness vendor space required.

• Experience with data aggregation, specifically clinical data preferred.

SKILLS

• Strong knowledge of HIPAA Privacy, HIPAA Security and HIPAA HITECH compliance

• Knowledge in SQL, Python, NumPy highly desired

• Working knowledge or use of PowerBI a plus

• Proficient knowledge in Microsoft products required

• Excellent verbal, presentation and written communications skills

• Strong project management skills, organizational and prioritization skills

• Ability to manipulate data in many formats to draw clinical conclusions

• Ability to work independently with little to moderate supervision

SALARY

$150,000 - $200,000

Department Account Management & Service

Required Experience: 10-15 years of relevant experience

Required Travel: Up to 50%

Required Education: Bachelor's degree (4-year degree)

HUB International Limited is an equal opportunity and affirmative action employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations. The EEO is the Law poster and its supplement is available here at http://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm .

EEOAA Policy (https://hubinternational.jobs/eeo/)

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