Your Role

The Clinical Quality Analytics and Informatics team delivers 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 - Consultant will report to the Clinical Quality Analytics Senior Manager with day-to-day oversight provided by the CalPERS analytic lead. In this role you will provide data, analytic and reporting support, in partnership with the Clinical Quality Department, for the BSC CalPERS HMO/PPO lines of business. This includes monthly executive reporting, tableau dashboards, member engagement and adhoc analytics.

Your Work

In this role, you will:

• Conduct independent analysis of high complexity under minimal supervision and guidance
• Develop analytical methods so that they may be subsequently delegated for production to Clinical Quality Analysts at lower levels
• Produce analysis of high complexity under the guidance and direction of Clinical Quality Analyst - Principal or manager
• Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Clinical Quality Analysts at lower levels and may involve collaboration with more than one team
• Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower level analysts and analysts in other Departments.
• Conduct independent analysis of high complexity under moderate supervision and guidance, develop novel analyses and reports
• Collect data from various internal systems (e.g. Claims processing or membership systems) and external systems (EMR/EHR) and converts those data to actionable insights to guide business decision making for BSC populations' health management and quality of care
• Develop, implement, and document quality assurance (QA) processes to ensure that reported data is accurate and reliable
• Conduct program evaluation, vendor assessments, performance guarantees using advanced statistical modeling
• Partner with the HEDIS data team, Clinical Quality Analytics and Medical Record Review teams to support HEDIS performance improvement initiatives

Your Knowledge and Experience

• 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 5 years of SAS/SQL programming experience
• Requires at least 7 years of prior operational and / or data analysis experience, experience in database structures, and standard query and reporting tools
• Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
• Requires at least 3 years of experience working with NCQA HEDIS quality measures
• Requires at least 3 years of experience with NCQA Health Plan Rating, CMS Medicare Advantage Star Rating or Medi-Cal Managed Care Accountability Sets (MCAS)
• Requires at least 5 years of programming using inpatient claims, outpatient encounters, membership, pharmacy or laboratory data.
• Requires at least 5 years of experience with ICD (International Classification of Diseases) codes, CPT (Current Procedural Terminology) codes, Diagnostic Related
• Proficient in MS Office - Word, Excel and Powerpoint
• Experience with visual management tools (eg. Tableau, Power BI) or task management tools (eg. JIRA, Work Front, Sharepoint) or cloud data (eg. Azure, AWS, Snowflake)
• Experience working with RDBMS: Oracle, Netezza, DB2 etc.
• Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
• Experience utilizing a certified HEDIS software

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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