Quality Measurement Analytics Consultant I​/II​/III

Job Description This position consults with internal and external stakeholders in order to extract, analyze and develop reports in ways that can be easily understood and complete with summaries and recommendations on findings to drive continuous improvement in measure results across all lines of business. Incumbents have the responsibility to understand HEDIS/CAHPS, Quality Assurance Reporting Requirements (QARR), Quality Rating System (QRS) reporting requirements along with influencing the Health Plan’s quality ratings performance.

The consultant monitors trends, outcomes and business processes using data mining techniques, statistical techniques, (i.e., control charting) and additional business intelligence technologies. This position partners with other analytical areas, project teams, external regulators and other Health Plans.

• Develops on-going knowledge of Health Plan’s data sources and structures to independently take in business requirements, design and execute on requests
• Independently seeks to understand the business/programs and partners at the Health Plan to better understand the business requirements (the ‘why’) of the request and applies both knowledge of the business and analytic skills to proactively fulfill request. Ultimately collaborates with business partners before and as the data is pulled so the most meaningful information is provided initially. Also, follows up with business partners to ensure timely completion of request and is available to communicate a clear and concise understanding of analysis.
• Participates on departmental and Health Plan project teams with other staff in the Health Plan providing detailed reports, outcome analysis and return on investment, if applicable.
• Prepares, develops, analyzes quality measure data. Ensures that all data are accurate and that the results are provided in a timely manner.
• Collaborates with other Quality Measurement Analytic Consulting team members, leveraging skill sets across the team and aiding in growth and development, as needed. Collaborates with the clinical team to advance partnerships and measure knowledge.
• Understands measure performance for assigned measures, future changes and design along with clinical insight from clinical team.
• Understanding of NCQA and Medicare STARS, Medicaid Quality Incentive, Quality Rating system requirements and results.
• Proactively problem solves, investigates and brings forward concerns to peers, management and other Health Plan analytical teams with relation to data pulls and analyses results.
• Uses appropriate analytic tools for particular data analysis (considering efficiency and automation of standard/repetitive reports) and documents logic to ensure that all reports are starting from the same source of truth to supply data that is in line with our Enterprise definitions.
• Proficient in HEDIS software system and reporting interface. Attends any pertinent mandatory training.
• Builds relationships across the organization and appreciation/understanding of other analytic units, business practices, product design and operational areas.
• Organizes and prioritizes tasks, proposes work assignments so as to successfully complete projects in a timely manner and completes desk level procedures as appropriate.
• Manages multiple projects, work streams with competing deadlines to successful completion.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Utilizes SAS, Cognos and Microsoft tools to develop reports as appropriate and in depth knowledge of HEDIS software, Health Plan EDW (or related claims data sets) or Medical/Pharmacy Management Systems while becoming familiar with the other data sets or systems.
• Trains and mentors peers.
• Participates/represents…