Clinical Report Analyst, Health Plan

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.

Work Shift:8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:40

Salary Range: $29.00 - $46.50

Union Position: No

Department DetailsWe are a tight knit group which prides itself on assisting one another toward the same common goal.

SummaryThe clinical 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 the 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.

Job Description

The Clinical 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 applicable teams, as appropriate, upon data findings. Provide clinical input to the Underwriting and Finance teams for quoting and renewing groups as well as 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 Underwriting, Finance, Actuary, Sales and Retention, Care Management teams 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. Limited travel may be required as necessary. Demonstrate proficiency with Epic/Tapestry and Microsoft applications.

QualificationsBachelor’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.

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 or send an email to .

R-0248869

Remote/Remotely/Tele/Telecommute/From home