Clinical Quality Analytics, Senior

2 weeks ago

Oakland, United States Blue Shield of California Full time

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 - Senior will report to the Clinical Quality Manager or Senior Manager. 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.

Your Work

In this role, you will:

  • Conduct independent analysis of high complexity under moderate supervision and guidance, develop novel analyses and reports
  • Develop documentation and create and execute workplans for analyses of high complexity 
  • Produce analysis of high complexity under the guidance and direction of Clinical Quality Analyst – Consultant or Principal or Manager
  • Design, build, and enhance data systems and applications so that they better serve specific reporting requirements
  • Identify business risks relating to report design and production
  • Collect data from various internal systems (example 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
  • Produce monthly provider and/or employer group specific reports based on HEDIS measures in alignment with reporting quality ratings systems such as NCQA Stars/Accreditation, Medicare Stars, Medi-Cal Managed Care Accountability Sets, Quality Transformation Initiative and Quality Rating System
  • 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 2 years of SAS/SQL programming experience
  • Requires at least 2 years of Tableau or Power BI development and visualization management
  • 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 PowerPoint
  • 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)
  • Tableau certifications preferred
  • Preferred experience with task management tools (eg. JIRA, Work Front, SharePoint) or cloud data (eg. Azure, AWS, Snowflake)
  • Mastery of at least two of the following: clinical coding, large-scale health databases, health statistics (e.g., epidemiology or health services), health insurance business principles preferred
  • Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency
  • Must be able to develop programs and scripts that can be used to repeatedly to generate reliable reports and analytics
  • Must exhibit level-appropriate competence in Departmental competency dimensions (Communication, Agile Learning, Business Knowledge, Creativity, Critical Thinking, Customer Focus, Drive for Results)
  • Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting
  • Experience utilizing a certified HEDIS software.

Pay Range:

The pay range for this role is: $ 99000.00 to $ 148500.00 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.

#LI-MM4

  • Clinical Quality Analytics, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Clinical Quality Analytics, Senior at Blue Shield of California summary: The Senior Clinical Quality Analytics role focuses on delivering high-quality clinical data analytics and informatics to support performance improvement and regulatory compliance at Blue Shield of California and Promise Health Plan. This position involves conducting complex data...

  • Clinical Quality Analytics, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Clinical Quality Analytics, Senior at Blue Shield of California summary: The Senior Clinical Quality Analyst plays a crucial role in the Clinical Quality Analytics and Informatics team, focusing on improving member-centered care through high-quality analytics and informatics. Responsibilities include conducting complex data analysis, producing actionable...

  • Clinical Quality Analytics, Senior

    1 week ago

    Oakland, United States Blue Shield of California Full time

    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 - Senior will...

  • Clinical Quality Analytics, Senior

    1 week ago

    Oakland, United States Blue Shield of California Full time

    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 - Senior will...

  • Clinical Quality Analytics, Senior

    2 weeks ago

    Oakland, CA, United States Blue Shield of California Full time

    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 - Senior will...

  • Senior Manager, Data Reporting and Analytics

    7 days ago

    Oakland, United States Kaiser Permanente Full time

    Description: Job Summary:This senior manager level position is primarily responsible for managing strategic data-informed decisions, managing data and information collection on targeted variables in an established systematic fashion, and managing data preparation for analytic efforts.This position manages the execution of creative data analytic approaches...

  • Senior Quality Specialist

    3 weeks ago

    Oakland, United States CCG Business Solutions, LLC Full time

    Company Description CCG Talent Management is not only a business solutions company but a company that believes success starts with the individual. CCG Business Solutions has been consulting and providing talent placement services since 2007. Our team understands the principles of connecting purpose to business. We are currently recruiting for a Senior...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Data Quality Engineer, Senior at Blue Shield of California summary:The Senior Data Quality Engineer at Blue Shield plays a critical role in testing Data & Analytics projects by developing and implementing test scenarios and scripts. This position requires collaboration with cross-functional teams to ensure data integrity and quality while maintaining...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Data Quality Engineer, Senior at Blue Shield of California summary: The Senior Data Quality Engineer will contribute to the BSC Data & Analytics Organization by developing and executing test scenarios and scripts for data-driven projects. This role involves collaboration with various teams to ensure high-quality data processes, including evaluating...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Data Quality Engineer, Senior at Blue Shield of California summary: As a Senior Data Quality Engineer, you will lead the testing services in Data & Analytics projects, focusing on developing test scenarios and scripts, conducting defect analysis, and ensuring quality assurance standards. You will collaborate with cross-functional teams to understand project...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Data Quality Engineer, Senior at Blue Shield of California summary: The Senior Data Quality Engineer in the BSC Data & Analytics Organization is responsible for developing and executing test scenarios, scripts, and plans to ensure the quality of data across various projects. This role requires collaboration with cross-functional teams and proficiency in...

  • Data Quality Engineer, Senior

    4 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Data Services Quality Engineering team is part of the BSC Data & Analytics Organization. We provide testing services for Data & Analytics projects. The data is sourced from various internal and external applications and loaded to the consumption layer. The Quality Engineer, Senior, will report to the IT Manager. In this role you will be working...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Data Services Quality Engineering team is part of the BSC Data & Analytics Organization. We provide testing services for Data & Analytics projects. The data is sourced from various internal and external applications and loaded to the consumption layer. The Quality Engineer, Senior, will report to the IT Manager. In this role you will be working...

  • Data Quality Engineer, Senior

    4 days ago

    Oakland, United States Blue Shield Of California Full time

    Your Role The Data Services Quality Engineering team is part of the BSC Data & Analytics Organization. We provide testing services for Data & Analytics projects. The data is sourced from various internal and external applications and loaded to the consumption layer. The Quality Engineer, Senior, will report to the IT Manager. In this role you will be working...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your RoleThe Data Services Quality Engineering team is part of the BSC Data & Analytics Organization. We provide testing services for Data & Analytics projects. The data is sourced from various internal and external applications and loaded to the consumption layer. The Quality Engineer, Senior, will report to the IT Manager. In this role you will be working...

  • Data Quality Engineer, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Data Services Quality Engineering team is part of the BSC Data & Analytics Organization. We provide testing services for Data & Analytics projects. The data is sourced from various internal and external applications and loaded to the consumption layer. The Quality Engineer, Senior, will report to the IT Manager. In this role you will be working...

  • Sr. Manager

    3 weeks ago

    Oakland, United States Acunor Full time

    Job Title: Senior Analytics Manager - Digital Marketing Analytics Location: San Francisco, CA (2-3 days per week in-office) About the Role: We are seeking a highly skilled and experiencedSenior Analytics Managerspecializing inDigital Marketing Analyticsto join our team in theBanking/FinTechindustry. This is a critical role, requiring a blend of technical...

  • Clinical Analytics Expert

    4 minutes ago

    Oakland, California, United States Blue Shield Of California Full time

    Job DescriptionThis role will focus on developing data analytics solutions to support the Network and Trend Analytics team. As a Medical Informatics Analyst, you will work closely with stakeholders to design and implement innovative analysis tools, leveraging your expertise in health science and data analysis.

  • Senior Product Manager

    21 hours ago

    Oakland, United States Fivetran Full time

    From Fivetran's founding until now, our mission has remained the same: to make access to data as simple and reliable as electricity. With Fivetran, customer data arrives in their warehouses, canonical and ready to query, with no engineering or maintenance required. We're proud that more organizations continue to leverage our technology every day to become...

  • Risk Adjustment Consulting, Senior

    4 weeks ago

    Oakland, United States Blue Shield of California Full time

    Risk Adjustment Consulting, Senior at Blue Shield of California summary: The Senior Risk Adjustment Consultant plays a crucial role in enhancing risk adjustment processes by collaborating with Provider Group leaders to improve recapture rates and ensure accurate coding practices. This position involves managing projects, analyzing data, and developing...