Clinical Quality Analytics, Senior

Your Role

Your Role replaced by heading; the original content describes the Clinical Quality Analytics and Informatics team delivering best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, and regulatory reporting. The Clinical Quality Analyst - Senior will report to the Clinical Quality Analytics Senior Manager with indirect accountability to the Clinical Quality Analytics Principal Lead.

In this role you will provide data, analytic and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department Health Care Service.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

• Requires a bachelor's degree in health science, quantitative social science, public health, health services research or business or equivalent experience
• Prefer an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business
• Requires at least 2 years of SAS/SQL programming experience
• Requires at least 5 years of prior operational and / or data analysis experience, experience in database structures, and standard query and reporting tools
• Proficient in MS Office - Word, Excel and Power Point
• Requires at least 2 years of programming using inpatient claims, outpatient encounters, membership, pharmacy or laboratory data
• Requires at least 2 years of experience with ICD (International Classification of Diseases) codes, CPT (Current Procedural Terminology) codes, Diagnostic Related Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
• Requires at least 3 years of experience in Health Care (managed care, academic, or gov't payer)
• Requires at least 1 year of experience working with NCQA HEDIS quality measures
• Requires at least 1 year of experience with NCQA Health Plan Rating, CMS Medicare Advantage Star Rating or Medi-Cal Managed Care Accountability Sets (MCAS)
• Experience with visual management (e.g. Tableau, Power BI) or task management tools (e.g. JIRA, Work Front, SharePoint) or cloud data (e.g. Azure, AWS, Snowflake) preferred
• Experience with two of the following is preferred: clinical coding, large-scale health databases, health statistics (e.g., epidemiology or health services), health insurance business principles
• Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency preferred
• Ability to develop programs and scripts that can be used to repeatedly generate reliable reports and analytics preferred
• Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting preferred
• Experience utilizing a certified HEDIS software