Clinical Quality Analytics, Consultant

Your Role

The Clinical Quality Analytics 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 - Consultant will report to the Clinical Quality Analytic Senior Manager under the day-to-day supervision of the Clinical Quality Analytics - Principal, Medicare Lead. 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 - Medicare quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department Health Care Service.

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 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
• Proficient in MS Office - Word, Excel and Powerpoint
• Experience with visual management tools (eg. Tableau, Power BI) or task management tools (eg. JIRA, Work Front, Sharepoint) or cloud data (eg. 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 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

• 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

• Experience utilizing 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)