Job Description

JOB SUMMARY

The Clinical Quality Analyst II works with the Clinical Analytics team to provide advanced and complex clinical and quality data analysis for the SWHP Medical Directors and the Quality Improvement Department to achieve the quality and regulatory goals and initiatives in our Strategic Plan. This includes HEDIS, CAHPS, HOS, and STAR measures, goals, and initiatives. By collaboratively working with business owners, leadership, other departments, and other Clinical/Quality staff, they will develop & distribute internal and external reports that support all Health Plan lines of business, ensuring these reports are always meaningful, accurate, and timely.

WHAT IS EXPECTED (ESSENTIAL FUNCTIONS)

Responsible for working with the Clinical Analytics department on key aspects of data collection and reporting including, but not limited to, quality planning (metrics/measures/initiatives), quality data gathering, quality reporting, performance improvement process, quality follow-up, and statistical significance testing, and report development and distribution

Responsible for data extraction, data load to the HEDIS software, model and reconcile large amounts of data across multiple system platforms and sources to meet all clinical/quality project requirements

Continuously review of trends of monthly quality data runs to proactively identify any data issues negatively affecting quality measures and actions needed with recommendations presented to system wide key leadership as needed

Provide advanced analysis of health care data, utilization, quality initiatives, outcome, and performance analysis for all clinical programs

Make verbal and written recommendations and programs for ~~system wide~~ quality process improvement purposes

Produce and distribute member and provider list reports from HEDIS software for all quality programs

Lead HEDIS benchmark variance investigation and participate in comprehensive post- HEDIS analyses to assess barriers, gaps and opportunities for improvement in conjunction with the CMO, the Director of Quality and/or the Clinical Analytics Manager

Respond to requests from the NCQA audit firm for explanation of identified variances from benchmarks by investigating and analyzing measure denominators and numerators

Lead in identification of data capture improvement and analysis of quality, claims data and member, provider information with reports back to the Director of Quality Improvement

Lead in development and distribution of reports that support all SWHP lines of business, such as: quality improvement reporting, pay for performance reporting, employer group specific quality reporting, provider group specific quality reporting, CMS and HHS reporting, and any clinical/quality ad hoc reporting, as requested

Develop and distribute complex quality measure reports on a scheduled/routine basis

Lead other data analyst in any report preparation of all reports to ensure reports are always meaningful, accurate and distributed timely, both internally and externally

Plan and execute data interventions as needed based on data analysis for Quality Measure improvement, including HEDIS, CAHPS, HOS, and STAR

Ensure clear and comprehensive process documentation, user guides and training materials are procedures are created

Act as back-up for other team members and departmental functions

Provide information, advanced analytical support, and ad hoc analytic project requests from all health plan medical directors Perform other duties as required in a competent, professional and courteous manner

KNOWLEDGE, SKILLS AND ABILITIES

Advanced knowledge of Business Objects, SSIS, SQL, SAS, SPSS, SSMS, ETL or other related database/statistical platforms

Advanced knowledge of Microsoft Applications, including Excel, Access, and PowerPoint

Robust problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action with minimal direction.

Excellent technical, interpersonal, written and oral communication skills

Experience with R

Experience with Power BI a plus.

Experience with Aginity, Netezza SQL, and/or IDW a plus.

BENEFITS

Our competitive benefits package includes the following
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
Tuition Reimbursement
PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

EDUCATION - Bachelor's

EXPERIENCE - A minimum of 6 years experience required