Clinical Quality Analytics, Senior

4 days 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 providing data analytics and reporting support to enhance quality performance within the healthcare sector. This position involves conducting complex analyses, developing reports, and ensuring compliance with regulatory requirements, thereby contributing to member-centered care. The analyst collaborates with various teams to generate actionable insights from data, helping to drive performance improvement and quality initiatives at Blue Shield of California and Promise Health Plan.

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


Keywords:

Healthcare Analytics, Clinical Quality, Data Analysis, HEDIS Measures, Quality Improvement, Regulatory Reporting, SQL, Tableau, Public Health, Managed Care

  • Clinical Quality Director

    6 days ago

    Oakland, California, United States Roots Community Health Center Full time

    Job Title: Clinical Quality DirectorAbout Us:Roots Community Health Center is a leading healthcare organization committed to delivering high-quality patient care. We are seeking a highly skilled Clinical Quality Director to join our team.Job Description:The Clinical Quality Director will play a critical role in driving quality improvement initiatives and...

  • Data Quality Engineer, Senior

    4 days 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 be responsible for developing test scenarios, scripts, and plans to ensure the quality of data for analytics projects. You will work closely with cross-functional teams to analyze requirements, automate testing processes, and maintain...

  • Senior Investment Portfolio Automation Specialist

    2 weeks ago

    Oakland, California, United States ShiftCode Analytics Full time

    Job Description">This role involves working with the Vanguard Personalized Indexing portfolio management team to design and build automations that improve the team's efficiency. The ideal candidate will have experience with investment systems and be able to effectively communicate with portfolio managers to rapidly build solutions.">Key...

  • Senior Clinical Contracts Specialist

    4 weeks ago

    Oakland, California, United States Abbott Laboratories Full time

    Abbott Laboratories: A Global Healthcare LeaderAre you a detail-oriented professional with excellent communication skills and experience in contract management? Do you thrive in a fast-paced environment where no two days are the same?We're looking for a Senior Clinical Contracts Specialist to join our team at Abbott Laboratories. As a key member of our...

  • Pharmacy Analytics Strategic Lead

    4 weeks ago

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

    Job OverviewThe Data & Analytics (D&A) team partners with enterprise-wide business stakeholders to apply the power of data and analytics to deliver new insights and data-driven solutions to accelerate business outcomes. As a Pharmacy Analytics Strategic Lead, you will report to the Senior Manager of Pharmacy Analytics and be responsible for working with key...

  • 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

    2 months 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

    3 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

    1 month 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 months 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...

  • Senior Portfolio Automation Specialist

    1 month ago

    Oakland, California, United States ShiftCode Analytics Full time

    ShiftCode Analytics is committed to providing a competitive compensation package to its contractors. Based on industry standards and the required skills for this position, we estimate an annual salary of $120,000 - $180,000.The successful candidate will have the opportunity to work with our team of experienced portfolio managers to design and build...

  • Senior Clinical Trial Manager

    2 months ago

    Oakland, United States CSG Talent Full time

    We have an exciting opportunity for motivated individuals to join our clinical operations team working to bring cell therapies to the clinical stage. Position Title: Senior Clinical Trial ManagerLocation: Alameda, CA (hybrid schedule)Reports to: Senior Clinical Operations Director Ideal candidate will have the following education & experience:Bachelor's...

  • Healthcare Quality Professional, Senior

    1 month ago

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

    About Us:At Blue Shield of California, we strive to improve the health outcomes of our members. We work with a broad spectrum of internal and external stakeholders to develop programs that are directly aligned to national standards for high-quality healthcare.The Role:We are seeking a skilled Senior Business Analyst to join our Provider & Plan Quality...

  • Senior Clinical Nurse Manager

    1 month ago

    Oakland, California, United States Alameda Health System Full time

    Job Title: Senior Clinical Nurse ManagerAbout the Role:This is a senior-level nursing management position responsible for overseeing the clinical operations of patient care areas. The successful candidate will be accountable for implementing policies, procedures, and regulatory requirements related to nursing care. This role requires strong leadership and...

  • Senior Business Analytics Specialist

    2 weeks ago

    Oakland, California, United States SEDAA Full time

    Job DescriptionSedaa is a company that values innovation and collaboration. We are seeking a highly motivated Senior Business Analyst to join our team and contribute to our success.The successful candidate will have the following responsibilities:Work with multiple teams within the Information Technology Organization to develop and utilize financial and...

  • Senior Clinical Data Coordinator

    2 weeks ago

    Oakland, United States GForce Life Sciences Full time

    Job Title: Senior Clinical Data CoordinatorLocation: Onsite in Alameda, CAPay: $68 - $72/hour ($136k - 144k/year)Job Summary: The Senior Clinical Data Coordinator will oversee both internal and outsourced data management activities supporting clinical research studies. The role includes leading Clinical Data Management Study subteams and collaborating with...

  • Risk Adjustment Consulting, Senior

    2 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    1 month ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    4 weeks ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    1 month ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...