Meridian

  • Network Analytics Team Lead

    Job Location US-MI-Detroit
    Job ID
    2018-7204
    Category
    Business Development
    Business Line
    CMC Corporate
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

     

    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

     

    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day In The Life Of Network Analytics Team Lead: 

     

    This position is responsible for leading the analysis of all Caidan Management’s current and potential lines of business networks with an emphasis on expansion of Caidan Management Company through new customer development and increased market share for Meridian Health Plan, Meridian Advantage and MeridianRx/SentinelRx. This position will also be responsible for researching new types of business, products and services with an emphasis on expansion of Caidan Management Company through new customer development and increased market share for Meridian Health Plan, Meridian Advantage and MeridianRx/SentinelRx.

    Responsibilities

    • Train all Network Analytics Analysts on the Quest Analytics Suite
    • Train all Network Analytics Analysts on all reporting types including but not limited to their requirements and structures
    • Complete and provide analysis of access availability and adequacy of network reporting for all Caidan Management current and potential lines of business
    • Assist in identifying and analyzing requests for proposals and assist in successful responses for Meridian Health Plan, Meridian Advantage and MeridianRx
    • Assist in prospecting and generating leads of potential providers
    • Creation of formal proposals and presentations working closely with the Proposal Development team, Business Development Department, Network Development Department, MeridianRx/SentinelRx team and the Communications Department
    • Maintain an in-depth knowledge of network standards in all CMCs contract requirements and any potential new LOBs
    • Complete and submit monthly Access Analysis and Adequacy Analysis Reports on all of CMC’s LOBs
    • Monitor CMC’s network based on specialties identified by CMC’s Quality Department
    • Complete all HSD reports for Pharmacy, Medicare, and Medicare-Medicare Plan
    • Complete all HSAG reporting for Illinois
    • Complete annual Access Analysis reports for the Quality Department
    • Work with the Corporate Provider Services Department to correct internal data
    • Assist the Network Development teams at identifying gaps in network and what areas and specialties to target to fill deficiencies
    • Researching new types of business, products and services for Caidan Management Company
    • Intelligence gathering on customers and competitors
    • Identifying and analyzing requests for proposals and assist in successful responses for Meridian Health Plan, Meridian Advantage and MeridianRx
    • Assist in designing business models and plans for all lines of business
    • Assist in Prospecting and generating leads for possible sales
    • Creation of formal proposals and presentations working closely with the Communications Department and the Chief Development Officer
    • Attend conferences and join trade groups
    • Assist in special projects assigned by the Executive Team
    •  

    Qualifications

    What you can bring to Meridian:

    • Pursuit of a Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is required
    • 2+ year(s) of top performance as a non-management Family Member during which leadership abilities were demonstrated is preferred.
    • Thorough knowledge of CMC’s mission and its operational structure
    • Thorough knowledge of managed health care industry
    • Thorough knowledge of CMC’s provider policies and procedures
    • Follow-up and follow-through skills
    • Strong organizational skills
    • Excellent communication, analytical and financial skills
    • Strong writing and presentation skills
    • Strong knowledge of MS Office, Excel, Access, Quest Analytics
    • Ability to communicate clearly and concisely both orally and via written documents
    • Ability to work as part of a team while meeting and maintaining individual goals and objectives
    • Leadership capabilities, self-motivation and outstanding ability to sell

    What Meridian can offer you:

    • Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. 

     

     

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