At Memorial Sloan Kettering (MSK), we're not only changing the way we treat cancer, but also the way the world thinks about it. By working together and pushing forward with innovation and discovery, we're driving excellence and improving outcomes.
For the 28th year, MSK has been named a top hospital for cancer by U.S. News & World Report. We are proud to be on Becker's Healthcare list as one of the 150 Great Places to Work in Healthcare in 2018, as well as one of Glassdoor's Employees' Choice Best Place to Work for 2018. We're treating cancer, one patient at a time. Join us and make a difference every day.
MSK is seeking a Sr. Actuary/Data Analytics Specialist to join our Managed Care Outcomes team. In this role, you will provide rigorous analysis for major decision processes at the hospital. In addition, you will be responsible for managed care rate development and strategies to convey Memorial's value proposition to Federal and Commercial insurance carriers. Furthermore, using quantitative models and data informatics, you will advise Management in evaluating strategic initiatives.
You Will Also:
Create strategies for Managed care contracting, currently in excess of $1.6 billion
Analyze, develop, and revise actuarial models for use in managed care case rate and capitation contracting
Develop strategies for maximization of managed care reimbursement
Create bundled payment mechanisms for reimbursement which highlights Memorial's competitive advantage to payors
Assist the Alliance of Dedicated Cancer Centers (ADCC) in analytics and modeling value based purchasing and measure development
Perform decision support analysis of hospital, regional, state, and national discharge and clinical databases with respect to case mix, utilization, cost, mortality, and outcomes
Perform statistical and trend analysis of outcome and utilization inferences
Evaluate and use systems designed to adjust data and conclusions using industry standard disease severity and staging systems for both inpatient and episodic treatment regimens
Responsible for developing and evaluating payment rates and strategies for Managed care contracting for hospital and physician services. Analyze, develop, and revise models to support contract negotiations by running alternate contract models to determine current contract performance vs proposed contract structure and rates. Help develop strategies for maximization of managed care reimbursement.
Assist in managed care contract language review for existing and new managed care contracts.
Manage payor contracts in the nThrive Contract Modeling Software.
Maintain a current database of all payor contracts including all essential terms and tracks contract renewal and expiration dates.
Work closely with billing management in the audit of hospital and physician payments to ensure payor compliance with contract payment methodologies. Assist with statistical and financial models and analysis for special financial projects prepared for internal and external review.
Perform payer-specific reporting and analysis of healthcare industry trends including the impact of government regulations.
Capable of building strong customer relationships and delivering customer-centric solutions
A good decision-maker, with proven success at making timely decisions that keep the organization moving forward
Able to work effectively in an environment notable for complex, sometimes contradictory information
Consistently achieving results, even under tough circumstances
Adept at planning and prioritizing work to meet commitments aligned with organizational
Adept at building partnerships and working collaboratively with others to meet shared objectives and goals
An effective communicator, capable of determining how best to reach different audiences and executing communications based on that understanding
Resilient in recovering from setbacks and skilled at finding detours around obstacles
Able to operate effectively, even when things are not clear or the way forward is not obvious
Adept at learning quickly, applying insights from past efforts to new situations
Master's Degree in Actuarial Science/Mathematics or equivalent work experience
7-10 years experience in healthcare analytics
Knowledge of SQL required; Statistics programming package (R, SAS, Python, SPSS, or MATLAB) a plus
MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Internal Number: 9045890
About Memorial Sloan-Kettering Cancer Center
As one of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, and superb educational programs. The close collaboration between our physicians and scientists is one of our unique strengths, enabling us to provide patients with the best care available today as we work to discover more effective strategies to prevent, control, and ultimately cure cancer in the future. Our education programs train future physicians and scientists, and the knowledge and experience they gain at Memorial Sloan-Kettering has an impact on cancer treatment and the biomedical research agenda around the world.