Clinical Quality Analytics, Consultant

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 - Consultant 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 Knowledge and Experience

• Requires a bachelor's degree in health science, quantitative social science, public health, health services research or business or equivalent experience.
• MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business preferred. 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 (e.g. Tableau, Power BI) or task management tools (e.g. JIRA, Work Front, SharePoint) or cloud data (e.g. Azure, AWS, Snowflake) preferred.
• Experience working with RDBMS: Oracle, Netezza, DB2 etc. preferred.
• 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 government payer)
• Requires at least 3 years of experience working with NCQA HEDIS quality measures.
• 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)