Job Information

Sanford Health Clinical Report Analyst, Health Plan in Sioux Falls, South Dakota

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

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Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00

Department Details

Monday through Friday, Primary hours 8 to 5 pm.

Job Summary

The clinical report analyst will perform analysis of health care claims and financial data to review, analyze and compile reports and trends as it relates to designated Health Plan clients. Provide clinical insight and expertise to Account Executive team and brokers for approaches needed to proactively manage the overall utilization of the client while incorporating integrated strategies to leverage appropriate resources, services, and programs. The clinical report analyst will review integrated clinical and administrative data to support business functions and processes. Work independently to compile and conduct ongoing analysis and evaluation of claims, reports and clinical data for quality, risk, forecasting and cost impact. Follow standard practices and procedures in analyzing situations or data from which answers can be researched and obtained. Provide referrals to case management team, as appropriate, upon data findings. Provide clinical input to the finance team for forecasting and risk identification. Maintain a working knowledge of the data sources to accurately and efficiently report findings in a meaningful, understandable and concise manner.

Establish effective mechanisms of communication with stakeholders and the organization's management team to foster an environment of openness, trust and team work. Complete special projects and management reports as assigned. Develop, analyze and monitor new, routine and ad hoc reports. Serve as a consultant with new business opportunities and plays a critical role in the annual renewal review of clients. Support Account Executives where needed on client engagement meetings, clinical review analysis and has effective presentation and communication skills. Communicate current medical management programs and cost containment strategies to assist in supporting client retention and addressing utilization trends. Collaborate with the integrated team and partners in order to provide a seamless exchange of information between internal departments including the sales and retention team, underwriters, care management and brokers with the ultimate outcome to improve quality, reduce costs and enhance the client experience.

Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Work primarily day hours and primarily in an office environment and onsite as needed. Travel may be required as necessary. Demonstrate proficiency with Microsoft applications.

Qualifications

Bachelor’s degree in nursing required.

Degree in nursing, graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Minimum of three years’ experience in the healthcare or health insurance industry required. Experience in data analytics and/or report development preferred.

Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Job Function: Health Plan
Req Number: R-63006
Featured: No