Overview
Clinical Quality Analytics, Consultant role at Blue Shield of California. The Clinical Quality Analytics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. The Clinical Quality Analyst - Consultant will report to the Clinical Quality Analytic Senior Manager under the day-to-day supervision of the Clinical Quality Analytics – Principal, Medicare Lead. This role provides data, analytic and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan - Medicare quality performance for regulatory and accreditation requirements including NCQA, CMS and the Department of Health Care Services.
Responsibilities
- Partner with the Clinical Quality Medicare Quality Improvement, Clinical Quality Analytics and Medical Record Review teams to support HEDIS performance improvement initiatives
- Conduct independent analysis of high complexity under minimal supervision and guidance
- Collect data from various internal systems (e.g., Claims processing or membership systems) and external systems (EMR / EHR) and convert those data to actionable insights to guide business decisions for Blue Shield of California populations' health management and quality of care
- Develop, implement, and document quality assurance (QA) processes to ensure that reported data is accurate and reliable
- Conduct program evaluation, vendor assessments, and performance guarantees using advanced statistical modeling
- Produce analysis of high complexity under the guidance of the Clinical Quality Analyst – Principal
- Develop documentation and create and execute workplans for analyses of high complexity; workplans may coordinate activities of Clinical Quality Analysts at lower levels and involve collaboration with more than one team
- Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials
Qualifications
Requires a bachelor's degree in health science, quantitative social science, public health, health services research or business or equivalent experiencePrefer an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or businessRequires at least 5 years of SAS / SQL programming experienceRequires at least 7 years of prior operational and / or data analysis experience, experience in database structures, and standard query and reporting toolsProficient in MS Office – Word, Excel and PowerPointExperience with visual management tools (e.g., Tableau, Power BI) or task management tools (e.g., JIRA, Workfront, SharePoint) or cloud data (e.g., Azure, AWS, Snowflake)Experience working with RDBMS : Oracle, Netezza, DB2 etc.Requires at least 5 years of programming using inpatient claims, outpatient encounters, membership, pharmacy or laboratory dataRequires at least 5 years of experience with ICD, CPT, APR-DRG / MS-DRG or HCPCS codesRequires at least 5 years of experience in Health Care (managed care, academic, or government payer)Requires at least 3 years of experience working with NCQA HEDIS quality measuresExperience utilizing certified HEDIS softwareRequires at least 3 years of experience with NCQA Health Plan Rating, CMS Medicare Advantage Star Rating or MCASAbout the Team and Blues Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus. Together, these organizations are referred to as the Ascendiun Family of Companies. Our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We foster an environment where all employees can thrive and contribute fully to address the needs of the communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Our values : Honest, Human, Courageous. Our workplace model combines in-person collaboration with flexibility, supporting hybrid or on-site work as appropriate for the role. Equal Employment Opportunity : external hires must pass a background check / drug screen. Qualified applicants will be considered without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status, in accordance with laws.
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