Current jobs related to Clinical Quality Analytics, Consultant - Oakland CA United States - Blue Shield of California
-
Clinical Quality Analytics, Consultant
3 months ago
United States, CA, Oakland Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
2 months ago
Oakland, CA, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
2 weeks ago
Oakland, CA, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual...
-
Clinical Quality Analytics, Consultant
2 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
1 month ago
Oakland, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
3 months ago
Oakland, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
2 months ago
Oakland, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Analytics, Consultant
2 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS...
-
Clinical Quality Consultant
5 days ago
Merced, CA, United States Clinical Management Consultants Full timeA leading acute care hospital located in Central California is now searching for an experienced Clinical Quality Consultant to join their award-winning healthcare team. Reporting to the Director of Quality, the Nurse Coordinator Quality Assurance will monitor and improve inpatient and outpatient medical record documentation, ensures compliance with all state...
-
Clinical Quality Consultant
3 weeks ago
Merced, CA, United States Clinical Management Consultants Full timeA leading acute care hospital located in Central California is now searching for an experienced Clinical Quality Consultant to join their award-winning healthcare team.Reporting to the Director of Quality, the Nurse Coordinator Quality Assurance will monitor and improve inpatient and outpatient medical record documentation, ensures compliance with all state...
-
Clinical Quality Analytics Specialist
1 week ago
Oakland, California, United States Blue Shield of California Full timeYour RoleThe Clinical Quality Measurement team oversees the annual HEDIS submissions and other quality measure submissions to regulatory bodies such as CMS, NCQA, and DHCS. The Medical Informatics Analyst, Consultant will report to the Senior Manager of Medical Informatics. In this capacity, you will support corporate and departmental strategies and...
-
Clinical Quality Analytics, Senior
1 month ago
Long Beach, CA, United States Blue Shield of California Full timeYour 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...
-
Clinical Quality Analytics, Senior
3 months ago
United States, CA, Long Beach, 90802 Blue Shield of California Full timeYour 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
Long Beach, CA, United States Blue Shield of California Full timeYour 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...
-
Program Manager Clinical, Consultant
1 day ago
Oakland, CA, United States Blue Shield of California Full timeYour Role The Medical Care Programs team is responsible for managing programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Clinical Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare...
-
Program Manager Clinical, Consultant
2 days ago
United States, CA, Oakland Blue Shield of California Full timeYour Role The Medical Care Programs team is responsible for managing programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Clinical Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare...
-
Data Reporting and Analytics Consultant III
1 month ago
Oakland, California, United States Kaiser Permanente Full timeRemote from any KP location in CA, OR, CO, WA, GA, MD, VA D.C. Only. ** PLEASE NOTE: Salary ranges are geographically based. The posted range is for the Bay Area, CA. Lower ranges will apply for other labor markets outside of Northern, CAJob Summary:This position is part of a best-in-class analytics function being established to turn the wealth of available...
-
Mgr, Clinical Analytics
1 month ago
United States Magellan Health Full timeManages primary data and analytics support for assigned business unit, working closely with national and local leadership to drive clinical analytics relative to risk adjustment (Medicare HCC, Medicaid CDPS-Rx), Quality (HEDIS/STARS), risk stratification and population health initiatives. Provides subject matter expertise on statistical techniques, data...
-
Program Manager Clinical, Consultant
2 days ago
Oakland, United States Blue Shield of California Full timeYour Role The Medical Care Programs team is responsible for managing programs that support members with their health care, drive cost of healthcare savings, and improve quality. The Clinical Program Manager, Consultant will report to the Senior Manager, Medical Care Programs. In this role you will manage a critical, cross-functional cost of healthcare...
-
Senior Medical Coding Consultant
2 weeks ago
Oakland, CA, United States Blue Shield of California Full timeYour Role The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual...
Clinical Quality Analytics, Consultant
1 month ago
Your Role
The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS submission process and effectively apply business knowledge and technical expertise to support the business initiatives to report clinical quality of care received by members. You will collect data from various internal systems (examples: Claims processing or membership systems) and external systems (EMR/EHR) and convert those data into actionable insights to guide business decision making for BSC population health management and quality of care. You will also support lower level analysts on programming and business knowledge acquisition.
Your Work
In this role, you will:
- Conduct independent analysis of high complexityand develops reports independently Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
- Communicate analytical results in graphs or summaries to various stakeholders.
- Develop documentation and create and execute workplans for analyses of high complexity.
- Prepare presentation materials that clearly convey information to appropriate internal and external Blue Shield audiences
- Provide training and mentoring for team members on best practices for analysis and Reporting
- Review and revise existing analytical processes for accuracy and efficiency. Identify existing inefficiencies and problems and take action to implement solutions
- Continuously refine and expand the technical, clinical, and financial content knowledge required to successfully complete these duties
- Develop, implement, and document quality assurance (QA) processes to ensure that reported data is accurate and reliable
- Recommend and implement solutions for identified problems/root cause pertaining to clinical data used for HEDIS reporting
- Assist junior team members through peer review, informal training, or mentoring
- Contribute to team success by accomplishing tasks as needed
Your Knowledge and Experience
- Requires a bachelors degree in health science, quantitative social science, public health, health services research or business or equivalent experience.Preferred a MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
- Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
- 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
- Experience working with RDBMS: Oracle, Netezza, DB2 etc.
- 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 Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
- Superior analytical skills required.
- Experience working with Clinical Quality data
- Experience working with RDBMS: Oracle, Netezza, DB2 etc.
- Ability to document processes. Excellent technical, interpersonal, written and oral communication skills required.
- Proficient in MS Office Word, Excel and PowerPoint
- 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 experience utilizing a certified HEDIS software
- 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)
- Individual should be self-starter motivated to correctly interpret business needs, possesses strong problem-solving skills, as well as technical expertise needed to do hands-on data analysis, research and programming work.
- Experience and ability to utilize a certified HEDIS software.
- Experience developing dashboard in Tableau is a plus
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.
#LI-MM4
