About the job
Job Description
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
Qualifications
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.
About The Team
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we’re going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office
- Hybrid – In a business unit approved office a few times per year to 3 days per week, on average
- Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements:
Office Environment – roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.