Clinical Quality Analytics, Senior

2 days ago

Lakewood, United States Blue Shield of California Full time

Your Role



Interested in learning more about this job Scroll down and find out what skills, experience and educational qualifications are needed.

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


Essential Functions include but not limited to:



  • Conducts analysis of moderate complexity and develops reports with guidance from manager and peers
  • Communicates analytical results in graphs or summaries to various stakeholders
  • Prepares presentation materials that clearly convey information to appropriate internal and external BlueShield audiences
  • Designs, builds, and enhances data systems and applications so that they better serve specific reporting requirements
  • Assist to develop documentation for all new and existing SAS programs 
  • Reviews and revises existing analytical processes for accuracy and efficiency
  • Identifies existing inefficiencies and problems and takes action to implement solutions
  • Assists junior team members through peer review, informal training, or mentoring
  • Seeks and provides advice to analysts in other departments and business units regarding standardization of business rules and methods for analysis and reporting
  • Produces accurate results under tight deadlines
  • Continuously refines and expands the technical, clinical, and financial content knowledge required to successfully complete these duties
  • Develops, implements, and documents quality assurance (QA) processes to ensure that reported data is accurate and reliable
  • Recommends and implements solutions for identified problems/root cause pertaining to clinical data used for HEDIS reporting
  • Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, or, external reporting
  • Contributes to team success by accomplishing tasks as needed

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 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 SAS/SQL programming experience
  • 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)
  • Preferred experience with visual management (eg. Tableau, Power BI) or 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. Must have sufficient familiarity with the technical and clinical concepts necessary to adequately perform the duties described above preferred
  • Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency preferred
  • Must be able to develop programs and scripts that can be used to repeatedly to generate reliable reports and analytics
  • Strong verbal and written communication skills
  • Must exhibit level-appropriate competence in Departmental competency dimensions (Communication, Agile Learning, Business Knowledge, Creativity, Critical Thinking, Customer Focus, Drive for Results).
  • Capable of managing deadlines and working simultaneously on a variety of tasks
  • Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting
  • Experience utilizing a certified HEDIS software preferred

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 days ago

    Lakewood, United States Blue Shield of California Full time

    Your RoleSkills, Experience, Qualifications, If you have the right match for this opportunity, then make sure to apply today.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...

  • Clinical Quality Analytics, Consultant

    2 days ago

    Lakewood, United States Blue Shield of California Full time

    Your RoleConsidering applying for this job Do not delay, scroll down and make your application as soon as possible to avoid missing out.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...

  • Licensed Clinical Social Worker, LCSW

    1 month ago

    lakewood, United States Senior Care Therapy Full time

     Licensed Clinical Social Worker LCSW What We Offer:   No Admin Tasks! No cancellations! No no-shows!  Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed!  401(k) Plan for FT or PT employees  Full Time offers Excellent Health, Vision, and Dental Insurance Benefits   Full Time offers...

  • CNA/HCA with Nurse Delegation Certificate

    4 weeks ago

    Lakewood, Washington, United States Senior Helpers Full time

    Transform Lives with Senior HelpersWe are seeking a compassionate and skilled CNA/HCA with Nurse Delegation Certificate to join our team as a Senior Helpers Caregiver. As a caregiver, you will provide one-on-one personal care to help our clients remain safe and independent in their home.What We Offer:Flexible Scheduling to fit your lifestyle and...

  • Senior Care Nurse

    1 month ago

    Lakewood, United States Five Star Senior Living Full time

    Job SummaryWe are seeking a compassionate and skilled Licensed Practical Nurse (LPN) to join our team at Five Star Senior Living. As a LPN, you will play a vital role in providing high-quality care to our residents and ensuring their physical and emotional well-being.Key ResponsibilitiesInstitute appropriate nursing interventions to stabilize residents'...

  • Utilization Management Nurse, Senior

    2 days ago

    Lakewood, United States Blue Shield of California Full time

    Your RoleIn order to make an application, simply read through the following job description and make sure to attach relevant documents.The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization...

  • Analytical Chemist Position

    4 weeks ago

    Lakewood, New Jersey, United States Actalent Full time

    Job Title: QC Analytical ChemistJob Description:We are seeking a highly skilled QC Analytical Chemist to join our team in a fast-paced GMP laboratory environment. As a key member of our quality control team, you will be responsible for performing analytical testing of raw materials and completing all necessary reporting and documentation within the QC...

  • Senior Medical Safety Quality Specialist

    4 weeks ago

    Lakewood, Washington, United States Terumo BCT Full time

    Job Summary:We are seeking a highly skilled Senior Medical Safety Quality Specialist to join our team at Terumo Blood and Cell Technologies. As a key member of our safety and quality team, you will play a critical role in ensuring the safety and performance of our post-market apheresis medical devices.Key Responsibilities:Provide clinical and apheresis...

  • Home Caregiver

    1 month ago

    Lakewood, United States Senior Helpers - South Tacoma, WA Full time

    Job Title: Home CaregiverWe are seeking a compassionate and dedicated Home Caregiver to join our team at Senior Helpers in South Tacoma, WA.Job Summary:As a Home Caregiver, you will provide one-on-one personal care to seniors in their homes, helping them maintain their independence and quality of life. You will assist with daily activities, provide...

  • Caregiver - Resident Support Specialist

    4 weeks ago

    Lakewood, United States Bickford Senior Living Full time

    Resident Care CoordinatorAt Bickford Senior Living, we are passionate about delivering high-quality care with a personal touch. As a Resident Care Coordinator, you will play a vital role in ensuring that our residents receive the best possible care and support.Develop and implement individualized care plans that meet the unique needs of each...

  • Senior Quality Engineer

    4 weeks ago

    Lakewood, Washington, United States Terumo BCT Full time

    Job DescriptionTerumo Blood and Cell Technologies is seeking an experienced Senior Quality Engineer - Supplier Collaboration to join our dynamic team. In this role, you will lead supplier quality initiatives during the product development lifecycle, ensuring that supplier components meet stringent quality and compliance standards from concept through...

  • Mandarin Speaking Caregiver

    4 weeks ago

    Lakewood, United States Senior Helpers - South Tacoma, WA Full time

    Job SummaryWe are seeking a part-time Caregiver who is fluent in Mandarin to join our team at Senior Helpers in South Tacoma, WA. As a Caregiver, you will provide one-on-one personal care to our clients, helping them to remain safe and independent in their homes.Responsibilities:Provide a helping hand with daily activities such as walking, dressing, and...

  • DSHS WSH Clinical Risk Management Registered Nurse

    4 weeks ago

    Lakewood, Washington, United States State of Washington Full time

    Clinical Risk Management Registered NurseWestern State Hospital is seeking a Clinical Risk Registered Nurse to support quality functions by reviewing and analyzing data related to patient safety and care quality. This role is responsible for identifying and mitigating risks to ensure high-quality patient care. The ideal candidate will have strong analytical...

  • Senior Underwriter

    1 month ago

    Lakewood, United States Swift Staffing Group Full time

    Senior Underwriter Job DescriptionWe are seeking a highly skilled Senior Underwriter to join our client's team in Lakewood, NJ. The ideal candidate will have extensive experience in Property and Casualty (P&C) insurance underwriting and a deep understanding of risk assessment, underwriting guidelines, and P&C insurance policies.Key...

  • Quality Assurance and Research

    4 weeks ago

    Lakewood, California, United States Michael Page Full time

    Job SummaryMichael Page is seeking a highly skilled Quality Assurance and Research & Development Manager to join our team. As a key member of our organization, you will be responsible for ensuring the highest quality standards in our food manufacturing processes.Key Responsibilities:Develop, implement, and maintain quality assurance programs to ensure...

  • Clinical Risk Management Registered Nurse

    4 weeks ago

    Lakewood, Washington, United States State of Washington Full time

    Clinical Risk Management Registered NurseWestern State Hospital is seeking a Clinical Risk Registered Nurse to support quality functions by reviewing and analyzing data related to patient safety and care quality. This role is responsible for identifying and mitigating risks to ensure high-quality patient care. Key responsibilities include:Conducting regular...

  • Senior Audit Accountant

    1 month ago

    Lakewood, New Jersey, United States Holman Frenia Allison, P.C. Full time

    Job OpportunityWe are seeking a highly skilled Senior Audit Accountant to join our team at Holman Frenia Allison, P.C. This is an excellent opportunity for a motivated professional to take on a lead role in our audit engagements and contribute to the growth and success of our firm.Key Responsibilities:Conduct audits and provide high-quality services to...

  • Senior Director of Finance for Skilled Nursing Homes

    4 weeks ago

    Lakewood, New Jersey, United States Recruit Secure Full time

    Recruit Secure, LLC is assisting our client in seeking a seasoned Senior Director of Finance with a proven track record in healthcare industry experience. Our client owns and operates numerous for-profit, long-term care Skilled Nursing Homes (SNF) in several Western US states. The Finance Director will be a key member of the management team responsible for...

  • Certified Caregiver

    6 months ago

    Lakewood, United States Bickford Senior Living Full time

    **Hiring All Shifts!! Join our DYNAMIC team at Bickford Senior Living as a Certified Caregiver! The Certified Caregiver supports resident care within the branch, ensuring that Resident’s daily needs are met in a compassionate way that maintains their dignity, allowing them to live their life to the fullest!  This position offers a full suite...

  • Quality Engineer II

    1 week ago

    Lakewood, United States ICONMA, LLC Full time

    Our Client, a Global Power Technology Leader company, is looking for a Quality Engineer II for their Lakewood, NY location. Responsibilities: Research and test the design, functionality and maintenance of products, equipment, systems and processes and develop quality standards. Ability tread and interpret blueprints, and evaluate product integrity and...